Author Contributions

Conceptualization, G.N., M.A., E.E.E., A.V., J.S.T., R.S.R., V.N.K., O.R.A., N.N.A. and A.K.S.; data curation, G.N., E.E.E., A.V., J.S.T., R.S.R., V.N.K., O.R.A., N.N.A. and A.K.S.; formal analysis, G.N., M.A., E.E.E., A.V., J.S.T., R.S.R., V.N.K. and A.K.S.; funding acquisition, M.A., E.E.E., J.S.T., R.S.R., V.N.K., O.R.A. and N.N.A.; investigation, G.N., M.A., E.E.E., A.V., J.S.T., R.S.R., V.N.K. and A.K.S.; methodology, G.N., M.A., E.E.E., A.V., J.S.T., O.R.A., N.N.A. and A.K.S.; project administration, G.N., M.A., E.E.E., A.V., J.S.T., R.S.R., V.N.K. and A.K.S.; resources, G.N., E.E.E., A.V., J.S.T., R.S.R., V.N.K., O.R.A. and N.N.A.; software, M.A., E.E.E., R.S.R., V.N.K., O.R.A., N.N.A. and A.K.S.; supervision: G.N., M.A., E.E.E., A.V., O.R.A., N.N.A. and A.K.S.; validation, M.A., E.E.E., A.V., J.S.T., R.S.R., V.N.K. and A.K.S.; visualization, G.N., E.E.E., A.V., J.S.T., R.S.R., V.N.K., O.R.A., N.N.A. and A.K.S.; writing—original draft, M.A., E.E.E., A.V., J.S.T., R.S.R., V.N.K., O.R.A. and N.N.A.; writing—review and editing: G.N., M.A., E.E.E., A.V., J.S.T., R.S.R., V.N.K., O.R.A., N.N.A. and A.K.S. All authors have read and agreed to the published version of the manuscript.

Funding

This study is supported via funding from Prince Sattam bin Abdulaziz University project number (PSAU/2023/R/1444).

Institutional Review Board Statement

The trial received acceptance from the department of ethical committee (DEC), Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia, with an approval number of RHPT/020/27. The DEC approved the subject consent form, treatment protocols, and outcome parameters measured in the trial. The trial was executed in accordance with the ethical guidelines laid down in the 1964 Declaration of Helsinki and was registered in the clinical trial registry with the registration number CTRI/2020/06/025600.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Data are not publicly available but can be obtained from the corresponding author on request.

Conflicts of Interest

The authors declared no conflict of interest.

Figure 1. Flow chart showing the study detail.

Figure 1. Flow chart showing the study detail.

Figure 2. Pre- and post-primary and secondary outcome measure scores of MMT, SMT, and control group.

Figure 2. Pre- and post-primary and secondary outcome measure scores of MMT, SMT, and control group.

Table 1. Demographic details of the MMT, SMT, and control groups.

Table 1. Demographic details of the MMT, SMT, and control groups.

Sr. NoVariable MMTSMT Control p-Value1Age (year)-32.8 ± 2.833.1 ± 2.632.5 ± 2.70.709 *2SexMale13 (46%)12 (43%)13 (46%)- Female15 (54%)16 (57%)15 (54%)-3Height (cm)-163.7 ± 4.1164.5 ± 3.9163.2 ± 4.30.492 *4Weight (kg)-68.74 ± 3.169.88 ± 3.469.12 ± 3.50.433 *5BMI (kg/m2)-24.2 ± 2.1823.9 ± 2.2324.3 ± 1.980.766 *6CGH duration (year)-6.5 ± 3.16.8 ± 3.45.8 ± 2.90.476 *7CGH frequency (per day)-0.72 ± 0.160.68 ± 0.150.74 ± 0.130.304 *8CGH intensity (0–10)-6.5 ± 1.67.1 ± 1.56.8 ± 1.50.347 *9Headache (side)Unilateral24 (86%)25 (89%)24 (86%)- Bilateral4 (14%)3 (11%)4 (14%)-10Neck painYes1415 (100%)14- (Associated pain)No10 (0%)1-

Table 2. Primary and secondary outcome variable analysis of MMT, SMT, and control groups.

Table 2. Primary and secondary outcome variable analysis of MMT, SMT, and control groups.

Variable MMTSMTControl p-Value1CGH frequency
(no. of days
per 4 weeks)Baseline17.2 ± 2.118.4 ± 1.917.8 ± 1.80.074 *4 weeks10.3 ± 1.513.8 ± 1.515.5 ± 1.50.0018 weeks5.5 ± 0.98.5 ± 0.812.2 ± 1.80.0016 months3.5 ± 0.65.5 ± 0.810.8 ± 1.50.001p-value0.0010.0010.001 2CGH pain intensity
(0–10)Baseline7.3 ± 0.67.5 ± 0.57.4 ± 0.50.380 *4 weeks3.7 ± 0.55.8 ± 0.56.3 ± 0.50.0008 weeks2.2 ± 0.43.8 ± 0.54.5 ± 0.50.0006 months0.7 ± 0.31.9 ± 0.43.8 ± 0.40.000p-value0.0010.0010.001 3CGH disability
(percentage)Baseline57.33 ± 6.2 56.47 ± 6.556.22 ± 5.80.781 *4 weeks43.11 ± 5.448.32 ± 5.851.28 ± 5.20.0018 weeks38.41 ± 4.142.35 ± 5.848.37 ± 4.20.0016 months32.21 ± 3.638.32 ± 4.145.22 ± 3.80.001p-value0.0010.0010.001 4Neck pain frequency
(no. of days
per 4 weeks)Baseline24.5 ± 3.523.3 ± 3.623.7 ± 2.90.397 *4 weeks16.1 ± 2.119.9 ± 2.520.8 ± 2.10.0018 weeks10.1 ± 1.513.9 ± 1.717.8 ± 1.60.0016 months3.2 ± 0.37.9 ± 0.815.6 ± 1.40.001p-value0.0010.0010.001 5Neck pain intensity
(0–10)Baseline7.5 ± 0.57.3 ± 0.67.2 ± 0.60.139 *4 weeks3.2 ± 0.46.1 ± 0.56.4 ± 0.50.0018 weeks2.4 ± 0.33.9 ± 0.54.7 ± 0.50.0016 months0.5 ± 0.31.5 ± 0.43.5 ± 0.40.001p-value0.0010.0010.001 6Neck pain threshold
(KPa)Baseline260.3 ± 22.9262.2 ± 23.5261.8 ± 22.90.948 *4 weeks269.2 ± 21.3273.1 ± 22.8263.3 ± 21.50.244 *8 weeks276.1 ± 20.1278.9 ± 20.5268.8 ± 20.60.167 *6 months287.1 ± 16.2280.1 ± 19.4270.7 ± 20.10.006p-value0.0010.0090.341 * 7Flexion rotation test (right side—degree)Baseline26.22 ± 7.125.97 ± 6.826.32 ± 6.90.981 *4 weeks32.43 ± 6.229.88 ± 6.128.28 ± 6.10.0438 weeks38.17 ± 6.533.92 ± 5.530.18 ± 6.30.0016 months45.48 ± 5.639.58 ± 5.231.19 ± 6.10.001p-value0.0010.0010.026 8Flexion rotation test (left side—degree)Baseline25.21 ± 6.624.82 ± 6.524.92 ± 5.90.205 *4 weeks31.92 ± 6.3 28.19 ± 6.325.81 ± 5.40.0018 weeks36.51 ± 5.534.97 ± 5.527.82 ± 5.40.0016 months43.94 ± 5.338.21 ± 5.430.62 ± 5.20.001p-value0.0010.0010.001 9Neck disability indexBaseline50.62 ± 10.251.58 ± 11.351.12 ± 10.30.888 *4 weeks36.79 ± 9.040.65 ± 8.942.62 ± 8.70.0498 weeks25.32 ± 5.332.15 ± 7.236.72 ± 7.50.0016 months10.81 ± 1.322.56 ± 5.232.63 ± 6.20.001p-value0.0010.0010.001 10Quality of lifeBaseline25.4 ± 4.724.2 ± 4.624.9 ± 3.80.591 *4 weeks49.8 ± 4.938.3 ± 4.735.3 ± 3.90.0018 weeks62.7 ± 5.152.6 ± 4.742.6 ± 4.00.0016 months80.3 ± 5.460.1 ± 4.948.2 ± 4.10.001p-value0.0010.0010.001

Table 3. Pre- and post-mean difference and confidence interval (upper limit and lower limit) scores of MMT, SMT, and control groups.

Table 3. Pre- and post-mean difference and confidence interval (upper limit and lower limit) scores of MMT, SMT, and control groups.

Variable/TimeBaseline4 Weeks8 Weeks6 MonthsMean Difference CI 95% (Upper Limit–Lower Limit)CGH frequency1MMT × SMT1.2 (−0.03 to 2.43)3.3 (2.34 to 4.25)3.0 (2.20 to 3.79)2.0 (1.33 to 2.66)MMT × Control0.6 (−0.60 to 1.83)5.0 (4.04 to 5.95)6.7 (5.90 to 7.49)7.3 (6.63 to 7.96)SMT × Control−0.6 (−1.83 to 0.63)1.7 (0.74 to 2.65)3.7 (2.90 to 4.49)5.3 (4.63 to 5.96)CGH pain intensity2MMT × SMT0.2 (−0.14 to 0.54)2.1 (1.78 to 2.41)1.6 (1.30 to 1.89)1.2 (0.96 to 1.43)MMT × Control0.1 (−0.24 to 0.44)2.6 (2.28 to 2.91)2.3 (2.00 to 2.59)3.1 (2.86 to 3.33)SMT × Control−0.1 (−0.44 to 0.24)0.5 (0.18 to 0.81)0.7 (0.40 to 0.99)1.9 (1.66 to 2.13)CGH disability3MMT × SMT−0.8 (−4.79 to 3.07)5.2 (1.71 to 8.70)3.9 (0.90 to 6.98)6.1 (3.66 to 8.55)MMT × Control−1.1 (−5.04 to 2.82)8.1 (4.67 to 11.66)9.9 (6.92 to 13.0)13.0 (10.5 to 15.4)SMT × Control−0.2 (−4.18 to 3.68)2.9 (−0.53 to 6.45)3.8 (2.77 to 4.82)6.9 (4.45 to 9.34)Neck pain frequency4MMT × SMT−1.2 (−3.33 to 0.93)3.8 (2.36 to 5.23)7.7 (6.67 to 8.72)4.7 (4.07 to 5.32)MMT × Control−0.8 (−2.93 to 1.33)4.7 (3.26 to 6.13)3.9 (2.87 to 4.92)12.4 (11.7 to 13.0)SMT × Control0.4 (−1.73 to 2.53)0.9 (−0.53 to 2.33)3.7 (3.54 to 3.85)7.7 (7.07 to 8.32)Neck pain intensity5MMT × SMT−0.2 (−0.56 to 0.16)2.9 (2.60 to 3.19)1.5 (1.21 to 1.78)1.0 (0.76 to 1.23)MMT × Control−0.3 (−0.66 to 0.06)3.2 (2.90 to 3.49)2.3 (2.01 to 2.58)3.0 (2.76 to 3.23)SMT × Control−0.1 (−0.46 to 0.26)0.3 (0.00 to 0.59)0.8 (0.51 to 1.00)2.0 (1.76 to 2.23)Neck pain threshold6MMT × SMT1.9 (−12.84 to 16.64)3.9 (−10.05 to 17.85)2.8 (−10.21 to 15.81)−7.0 (−18.8 to 4.89)MMT × Control1.5 (−13.24 to 16.24)−5.9 (−19.85 to 8.05)−7.3 (−20.31 to 5.71)−16.4 (−28.2 to −4.5)SMT × Control−0.4 (−15.14 to 14.34)−9.8 (−23.75 to 4.15)−10.1 (−23.11 to 2.9)−9.4 (−21.2 to 2.49)Flexion rotation test (right side)7MMT × SMT−0.2 (−4.67 to 4.17)−2.5 (−6.46 to 1.36)−4.2 (−7.83 to −0.66)−5.9 (−9.58 to −2.21)MMT × Control−0.2 (−4.67 to 4.17)−4.1 (−8.06 to −0.23)−7.9 (−11.57 to −4.4)−14.2 (−17.9 to −10.6)SMT × Control0.3 (−4.07 to 4.77)−1.6 (−5.51 to 2.31)−3.7 (−7.32 to −0.15)−8.3 (−2.0 to −4.7)Flexion rotation test (left side)8MMT × SMT−0.3 (−4.43 to 3.65)−3.7 (−7.56 to 0.10)−1.5 (−5.02 to 1.94)−5.7 (−9.15 to −2.3)MMT × Control−0.2 (−4.33 to 3.75)−6.1 (−9.94 to −2.27)−8.6 (−12.17 to −5.2)−13.3 (−16.7 to −9.8)SMT × Control0.1 (−3.94 to 4.14)−2.38 (−6.21 to 1.45)−7.1 (−10.63 to −3.66)−7.5 (−11.0 to −4.16)Neck disability index9MMT × SMT0.9 (−5.81 to 7.73)3.8 (−1.79 to 9.51)6.8 (2.53 to 11.12)11.7 (8.57 to 14.9)MMT × Control0.5 (−6.27 to 7.27)5.8 (0.17 to 11.4)11.4 (7.10 to 15.69)21.8 (18.64 to 24.99)SMT × Control−0.4 (−7.23 to 6.31)1.9 (−3.68 to 7.62)4.5 (0.27 to 8.86)10.0 (6.89 to 13.2)Quality of life10MMT × SMT−1.2 (−3.99 to 1.59)−11.5 (−14.38 to −8.6)−10.1 (−13.0 to −7.1)−20.2 (−23.2 to −17.1)MMT × Control−0.5 (−3.29 to 2.29)−14.5 (−17.3 to −11.6)−20.1 (−23.0 to −17.1)−32.1 (−35.1 to −29.0)SMT × Control0.7 (−2.09 to 3.49)−3.0 (−5.88 to −0.11)−10.0 (−12.9 to −7.05)−11.9 (−14.9 to −8.81)