Comparative Study on SNAG From Different Positions Low Back Pain Treatment

NCT07215286 | Completed

• 1 other identifier: H-2025-910
• Study Type: interventional
• Target: 59
• Locations: 1 country
• Sites: 1

Brief Summary

Objectives: To compare the effects of lumbar sustained natural apophyseal glides (SNAGs) applied in loaded versus unloaded positions on pain, disability, and function in individuals with chronic nonspecific LBP. Methods: A sample of 59 participants was assigned to receive six sessions of standard intervention, with lumbar SNAGs applied in either a loaded (sitting) or an unloaded (quadruped) position. This study was conducted between November 2025 and May 2026. Outcomes measured pre- and post-intervention included pain intensity (VAS), lumbar flexion range of motion (BROM device), and functional disability (Oswestry Disability Index).

Conditions

Chronic Low Back Pain (CLBP)

Keywords

Manual therapy; Mobilization with Movement; Spine; Mulligan

Outcome Measures

Primary Outcomes (2)

• Pain intensity

  Visual analogue scale (VAS), which is a 10-cm line, 0 denotes no pain and 10 the most intense agony.

  1 week

• Lumbar flexion ROM

  The BROM is an electronic goniometer that will be used to evaluate the range of motion for trunk flexion

  1 week

Secondary Outcomes (1)

• Functional disability

  1 week

Study Arms (2)

Loaded-SNAG

ACTIVE COMPARATOR

SNAGs from standing position

Procedure: Loaded-SNAG; Procedure: Unloaded-SNAG

Unloaded-SNAG

ACTIVE COMPARATOR

SNAG from quadruped position

Procedure: Loaded-SNAG; Procedure: Unloaded-SNAG

Interventions

Loaded-SNAG 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.

Loaded-SNAG; Unloaded-SNAG

Unloaded-SNAG 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).

Loaded-SNAG; Unloaded-SNAG

Eligibility Criteria

• Age: 20 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• University of Hail: lead

Study Sites (1)

University Medical Clinics

Ha'il, 0000, Saudi Arabia

Location

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Participants were randomized into either the SNAG-loaded Group or the SNAG-unloaded Group. Randomisation was performed using the permuted blocks method. The allocation process was conducted by a coworker who was not involved in either the assessment or intervention procedures. The outcome assessor was blinded to group allocation. Participants could not be blinded due to the nature of the interventions. The therapist was not blinded for practical reasons. Statistical analysis was performed by an independent analyst blinded to group assignment using coded group identifiers (A and B).
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: October 2, 2025
• First Posted: October 10, 2025
• Study Start: October 15, 2025
• Primary Completion: May 30, 2026
• Study Completion: May 30, 2026
• Last Updated: September 9, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

SA (1)