Comparative Study on SNAG From Different Positions Low Back Pain Treatment

NCT07215286 | Not Yet Recruiting

• 1 other identifier: H-2025-910
• Study Type: interventional
• Target: 34
• Locations: 1 country
• Sites: 1

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

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

Hail, 0000, Saudi Arabia

Location

Central Study Contacts

Ehab Ahmed, PhD

CONTACT

+966564032363; ehabkamelpop@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• 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: December 30, 2025
• Study Completion: January 15, 2026
• Last Updated: October 10, 2025

Record last verified: 2025-10

Data Sharing

• IPD Sharing: Will not share

Locations

SA (1)