Comparative Study on SNAG From Different Positions Low Back Pain Treatment

NCT ID: NCT07215286

Last Updated: 2025-10-10

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 34 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-10-15
• Study Completion Date: 2026-01-15

Brief Summary

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.

Conditions

Non Specific Chronic Low Back Pain

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Loaded-SNAG

SNAGs from standing position

Group Type: ACTIVE_COMPARATOR

Loaded-SNAG

Intervention Type: PROCEDURE

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 flexion glide. The therapist applies accessory glide to targeted zygapophyseal level while the patient actively performs symptomatic movement (e.g., forward flexion), performing repetitions with the therapist maintaining the glide.

Unloaded-SNAG

Intervention Type: PROCEDURE

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).

Unloaded-SNAG

SNAG from quadruped position

Group Type: ACTIVE_COMPARATOR

Loaded-SNAG

Intervention Type: PROCEDURE

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 flexion glide. The therapist applies accessory glide to targeted zygapophyseal level while the patient actively performs symptomatic movement (e.g., forward flexion), performing repetitions with the therapist maintaining the glide.

Unloaded-SNAG

Intervention Type: PROCEDURE

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).

Interventions

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 flexion glide. The therapist applies accessory glide to targeted zygapophyseal level while the patient actively performs symptomatic movement (e.g., forward flexion), performing repetitions with the therapist maintaining the glide.

Intervention Type: 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).

Intervention Type: PROCEDURE

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

• Minimum Eligible Age: 20 Years
• Maximum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Hail

OTHER

Sponsor Role: lead

Responsible Party

Ehab Mohamed Kamel Ahmed

Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

University Medical Clinics

Hail, , Saudi Arabia

Countries

Saudi Arabia

Central Contacts

Ehab Ahmed, PhD

Role: CONTACT

ehabkamelpop@gmail.com

+966564032363

Facility Contacts

Ehab Ahmed

Role: primary

ehabkamelpop@gmail.com

0564032363

Other Identifiers

H-2025-910

Identifier Type: -

Identifier Source: org_study_id