<b>Comparative Effectiveness of SNAGs Versus NAGs in Reducing Pain and Increasing Chest Mobility in Kyphoscoliosis Patients with Parkinsonism</b>

Background: Kyphoscoliosis is a complex spinal deformity commonly associated with Parkinsonism, leading to impaired postural alignment, restricted chest expansion, pain, and diminished quality of life. Manual therapy techniques such as Sustained Natural Apophyseal Glides (SNAGs) and Natural Apophyseal Glides (NAGs) are frequently employed for musculoskeletal disorders but their comparative effectiveness in Parkinsonism-related kyphoscoliosis remains unclear. Objective: To compare the short-term effects of SNAGs and NAGs on pain reduction and chest mobility in patients with Parkinsonism and kyphoscoliosis. Methods: In this double-blind randomized controlled trial, 60 patients with Parkinsonism and kyphoscoliosis were randomly assigned to either SNAGs (n=30) or NAGs (n=30) groups. Interventions were administered three times per week for four weeks. Primary outcomes included change in pain intensity, assessed by the Visual Analog Scale (VAS), and chest mobility, measured as thoracic expansion. Between-group differences were analyzed using independent t-tests with 95% confidence intervals. Results: Both groups demonstrated significant within-group improvements in pain and chest expansion. The SNAGs group achieved greater reductions in VAS scores (–3.1 ± 0.4) compared to the NAGs group (–1.5 ± 0.5; p=0.001), and greater increases in chest mobility (+1.7 ± 0.3 cm vs. +0.8 ± 0.3 cm; p<0.001). A moderate positive correlation was observed between pain reduction and chest mobility improvement in the SNAGs group (r=0.46). Conclusion: SNAGs are more effective than NAGs in reducing pain and improving chest mobility in patients with Parkinsonism-related kyphoscoliosis, supporting their preferential use in rehabilitation practice.