Comparative Study on SNAG From Different Positions Low Back Pain Treatment
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Loaded-SNAG, Unloaded-SNAG.
- Who it may be relevant to
- Registry conditions: Non Specific Chronic Low Back Pain. Basic parameters: 20 years — 40 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Saudi Arabia
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Comparative Study on SNAG From Loaded and Unloaded Position in the Treatment of Low Back Pain
Overview
Background: Low back pain (LBP) is a leading cause of disability worldwide. Mulligan's Sustained Natural Apophyseal Glides (SNAGs) are manual therapy techniques shown to reduce pain and improve function in LBP. However, whether applying SNAGs in loaded (weight-bearing) versus unloaded (non-weight-bearing) positions yields superior clinical outcomes remains unclear. Objective: To compare the effects of lumbar SNAGs applied in loaded versus unloaded positions on pain, disability, and function in individuals with chronic non-specific LBP. Methods: A randomized, single-blind, parallel-group clinical trial will recruit 34 participants with chronic LBP. Participants will be allocated to receive SNAGs in either loaded or unloaded positions, combined with a standardized exercise program, for 6 sessions over 1 week. The primary outcome is pain intensity (Numeric Pain Rating Scale) and lumbar flexion range of motion. Secondary outcomes include disability (Oswestry Disability Index). Outcomes will be measured at baseline and immediately post-treatment. Data will be analyzed using linear mixed models on an intention-to-treat basis. Conclusion: This trial will determine whether a loaded SNAG application provides superior benefits compared to unloaded SNAG in the treatment of chronic LBP. Findings may guide clinical decision-making and optimize manual therapy application.
Interventions
- Procedure Loaded-SNAG
patients will receive SNAGs from standing (Loaded-SNAG), step-stance, or functional position that provokes symptoms. A specialized Mulligan belt was used around the patient's waist and the therapist's hips. The mobilizing force was applied parallel to the facet joint plane (cephalic direction) and over the spinous processes of the respective symptomatic spinal levels. The therapist's hand's ulnar aspect was used over the spinous process of the superior vertebra of the involved segment for flexio - Procedure Unloaded-SNAG
patients will receive unloaded SNAG from quadruped position to reduce the axial loading. The therapist applies the equivalent accessory glide at the symptomatic spinal level while the patient performs the symptomatic movement (modified to be non-weight-bearing).
Primary outcome measures
- Pain intensity [Time frame: 1 week]
- Lumbar flexion ROM [Time frame: 1 week]
Secondary outcome measures (1)
- Functional disability [Time frame: 1 week]
Eligibility criteria
Inclusion criteria
- Chronic non specific low back pain for 6 weeks or more
- Who scored between three and six on a visual analogue scale (VAS)
- Restriction of the movement was only in flexion ROM
Exclusion criteria
- Pregnancy,
- Obese,
- Infectious conditions of the spine,
- Autoimmune disorders,
- Malignancy
- Any contraindication to physiotherapy and manual therapy
- Any patient received physical therapy sessions last 6 months
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Single blind
- Primary purpose
- Treatment
Study locations
Saudi Arabia · 1 center
- University Medical Clinics — Ha'il
Identifiers
NCT: NCT07215286 · H-2025-910