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NCT Number: NCT07215286

Comparative Study on SNAG From Different Positions Low Back Pain Treatment

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.

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Key information

Conditions

Non Specific Chronic Low Back Pain

Age range

20 year–40 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

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.

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).

Primary outcomes

  1. Pain intensity

    Time frame: 1 week

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

  2. Lumbar flexion ROM

    Time frame: 1 week

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

Secondary outcomes

  1. Functional disability

    Time frame: 1 week

    The functional level was assessed using a validated Arabic version of the Oswestry Disability Index (ODI). A total score will be calculated, the percentage of disability (score obtained divided by 50 and multiplied by 100) ranged from 0% (no disability) to 100% (complete disability).

Study contacts

Contact information is provided by the study sponsor or research team.

Ehab Ahmed, PhD

CONTACT

[email protected]

+966564032363

Sponsors and collaborators

Lead sponsor

University of Hail

Other

Registry information

Official study title

Comparative Study on SNAG From Loaded and Unloaded Position in the Treatment of Low Back Pain

Important dates

Study start
2025
Primary completion
2025
Study completion
2026
First posted
Oct 10, 2025
Registry last updated
Oct 10, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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