{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T01:03:59Z","timestamp":1793754239277,"version":"4.6.1"},"reference-count":65,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiotherapy Res Intl"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Purpose<\/jats:title><jats:p>Mulligan's techniques, such as Sustained Natural Apophyseal Glides (SNAGs) and Natural Apophyseal Glides (NAGs), are commonly applied by physiotherapists when treating patients with non\u2010specific neck pain (NP). However, there has been no comprehensive synthesis of their effects in NP. This review aimed to assess the effectiveness of Mulligan's techniques in reducing pain, improving disability, and enhancing cervical range of motion (CROM) in adults with acute, subacute, or chronic NP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review with meta\u2010analysis was conducted on randomized controlled trials (RCTs) comparing Mulligan's techniques with other interventions in adults with NP. Two reviewers independently conducted study selection, data extraction, and risk of bias (RoB) assessment. Meta\u2010analyses were performed when clinical homogeneity was present; otherwise, a narrative synthesis was used. Certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010three studies were included. For acute and mixed (acute\/subacute\/chronic) NP, Mulligan's techniques were no more effective than other interventions for pain reduction, disability improvement, or CROM enhancement. However, in patients with chronic or uncertain chronicity NP, SNAGs combined with other interventions demonstrated superior outcomes\u2014both statistically and sometimes clinically\u2014compared to certain treatments like exercises and muscle\u2010energy techniques, for reducing pain and disability and improving CROM. The certainty of evidence was rated very low.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Mulligan's techniques appear to be safe, simple, and potentially beneficial for managing mixed or chronic NP when combined with other interventions, presenting results that may be comparable or occasionally superior to other standard techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications for Physiotherapy Practice<\/jats:title><jats:p>Physiotherapists may consider incorporating Mulligan's techniques, especially SNAGs, within broader NP treatment strategies, as they offer a feasible, low\u2010risk option for improving patient outcomes, particularly for chronic NP cases when used alongside other therapies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pri.70045","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T08:03:37Z","timestamp":1748505817000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Effectiveness of Mulligan's Techniques in Non\u2010Specific Neck Pain: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9867-3788","authenticated-orcid":false,"given":"Jordana","family":"Barbosa\u2010Silva","sequence":"first","affiliation":[{"name":"Physical Therapy Department Federal University of S\u00e3o Carlos  S\u00e3o Carlos Brazil"},{"name":"Faculty of Business and Social Sciences University of Applied Sciences  Osnabr\u00fcck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Luc","sequence":"additional","affiliation":[{"name":"Neuro Musculo Skeletal Lab Institute of Experimental and Clinical Research Universit\u00e9 Catholique de Louvain  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Izabela","family":"Sobral de Oliveira\u2010Souza","sequence":"additional","affiliation":[{"name":"Faculty of Business and Social Sciences University of Applied Sciences  Osnabr\u00fcck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Martins de Abreu","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy LUNEX University International University of Health  Differdange Luxembourg"},{"name":"LUNEX ASBL Luxembourg Health &amp; Sport Sciences Research Institute  Differdange Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakelline","family":"Cipriano","sequence":"additional","affiliation":[{"name":"University of Pernambuco  Recife Brazil"},{"name":"Federal Institute of Education Science and Technology of Alagoas  Macei\u00f3 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marine","family":"de Schaetzen","sequence":"additional","affiliation":[{"name":"Neuro Musculo Skeletal Lab Institute of Experimental and Clinical Research Universit\u00e9 Catholique de Louvain  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Pitance","sequence":"additional","affiliation":[{"name":"Neuro Musculo Skeletal Lab Institute of Experimental and Clinical Research Universit\u00e9 Catholique de Louvain  Brussels Belgium"},{"name":"Stomatology and Maxillofacial Surgery Department Cliniques Universitaires Saint\u2010Luc Universit\u00e9 Catholique de Louvain  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Armijo\u2010Olivo","sequence":"additional","affiliation":[{"name":"Faculty of Business and Social Sciences University of Applied Sciences  Osnabr\u00fcck Germany"},{"name":"Department of Physical Therapy Faculty of Rehabilitation Medicine University of Alberta  Edmonton Canada"},{"name":"Faculty of Medicine and Dentistry University of Alberta  Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.5114\/pq.2023.117224"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/amhs.amhs_8_18"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.15537\/smj.2021.1.25589"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.304.5148"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtumed.2021.03.006"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20070147"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0096920"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2020.102212"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2017.0302"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/2856375"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2018.08.019"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40945-022-00144-3"},{"key":"e_1_2_12_14_1","first-page":"1","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J.","year":"1988"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-016-4467-7"},{"key":"e_1_2_12_16_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.4 (Updated August 2023)","author":"Deeks J. J.","year":"2023"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.4328\/JCAM.5715"},{"issue":"6","key":"e_1_2_12_18_1","first-page":"274","article-title":"Sustained Natural Apophyseal Glides Mobilization Versus Manipulation in the Treatment of Cervical Spine Disorders: A Randomized Controlled Trial","volume":"2","author":"El\u2010Sodany A. M.","year":"2014","journal-title":"International Journal"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2017.07.005"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.3109\/09593985.2014.963904"},{"issue":"3","key":"e_1_2_12_21_1","first-page":"482","article-title":"Comparison of Maitland and Mulligan Mobilization in Improving Neck Pain, ROM and Disability","volume":"2","author":"Gautam R.","year":"2014","journal-title":"International Journal of Physiotherapy and Research"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2665-9913(23)00321-1"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004250.pub5"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1054\/math.2002.0465"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2012.07.005"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1054\/math.2002.0440"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.3233\/BMR-169615"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/9780470712184.ch8"},{"key":"e_1_2_12_30_1","unstructured":"Hing W. T.Hall andB. R.Mulligan.2020.The Mulligan Concept of Manual Therapy: Textbook of Techniques."},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.21649\/akemu.v22i1.792"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.math.2013.12.002"},{"key":"e_1_2_12_33_1","first-page":"31144","article-title":"Effect of Maitland Mobilization Versus Mulligan (SNAGs) Mobilization on Head Repositioning Accuracy (HRA), Pain and Functional Disability in Patients With Chronic Neck Pain\u2010A Randomized Controlled Clinical Trial","volume":"8","author":"Keyur M. P.","year":"2016","journal-title":"International Journal of Current Research"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2017.11.007"},{"issue":"1","key":"e_1_2_12_35_1","first-page":"154","article-title":"Efficacy of Mulligan Concept (NAGs) on Pain at Available End Range in Cervical Spine: A Randomised Controlled Trial","volume":"5","author":"Kumar D.","year":"2011","journal-title":"Indian Journal of Physiotherapy and Occupational Therapy"},{"issue":"2","key":"e_1_2_12_36_1","first-page":"121","article-title":"Mobilization Versus Manipulations Versus Sustain Apophyseal Natural Glide Techniques and Interaction With Psychological Factors for Patients With Chronic Neck Pain: Randomized Controlled Trial","volume":"51","author":"Lopez\u2010Lopez A.","year":"2015","journal-title":"European Journal of Physical & Rehabilitation Medicine"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.47391\/JPMA.981"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.13189\/saj.2020.080610"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.47750\/jptcp.2023.30.08.042"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/pri.1767"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijosm.2021.06.002"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbmt.2024.02.009"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.16965\/ijpr.2019.104"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215518778321"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.3233\/PPR-180116"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.15621\/ijphy\/2017\/v4i2\/141947"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1080\/10669817.2021.1955181"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-157-6-201209180-00537"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.4103\/injms.injms_30_21"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.5281\/zenodo.1481977"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1142\/S1013702523500154"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physio.2018.10.001"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7280.226"},{"issue":"2","key":"e_1_2_12_55_1","first-page":"96","article-title":"Muscle Energy Technique Augmented With Sustained Natural Apophyseal Glides; an Effective Way to Improve Mechanical Neck Pain and Range of Motion: A Randomized Control Trial","volume":"16","author":"Sultan N.","year":"2021","journal-title":"Journal of Islamic International Medical College"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-55181-8"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.5455\/ijtrr.00000097"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.16965\/ijpr.2017.253"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.21649\/akemu.v23i4.2190"},{"key":"e_1_2_12_60_1","first-page":"195","volume-title":"Comparative Effect of Muscle Energy Techniques and Mulligan Mobilization on Pain & Range of Motion in Patients With Mechanical Neck Pain","author":"Usama J.","year":"2022"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.7860\/JCDR\/2022\/55962.16547"},{"key":"e_1_2_12_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61729-2"},{"key":"e_1_2_12_63_1","doi-asserted-by":"publisher","DOI":"10.21649\/akemu.v23i3.2007"},{"key":"e_1_2_12_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2019.101657"},{"key":"e_1_2_12_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2018.12.001"},{"issue":"2","key":"e_1_2_12_66_1","article-title":"The Short and Mid\u2010Term Effects of Mulligan Concept in Patients With Chronic Mechanical Neck Pain","volume":"2","author":"Zemadanis K.","year":"2018","journal-title":"Journal of Novel Physiotherapy and Rehabilitation"}],"container-title":["Physiotherapy Research International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pri.70045","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T13:37:45Z","timestamp":1754660265000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pri.70045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,29]]},"references-count":65,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/pri.70045"],"URL":"https:\/\/doi.org\/10.1002\/pri.70045","archive":["Portico"],"relation":{},"ISSN":["1358-2267","1471-2865"],"issn-type":[{"value":"1358-2267","type":"print"},{"value":"1471-2865","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,29]]},"assertion":[{"value":"2024-03-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70045"}}