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Completed

NCT Number: NCT07415538

Effects of Mulligan SNAG in Chronic Nonspecific Low Back Pain

The aim of this randomized controlled study was to compare the effects of Mulligan SNAG added to conventional physiotherapy with conventional physiotherapy alone and sham SNAG on pain, function, proprioception, and functional performance in individuals with chronic nonspecific low back pain.

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Key information

Conditions

Nonspecific Chronic Low Back Pain Manuel Therapy Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Physical Therapy Signs and Symptoms

Age range

18 year–65 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Biruni University

Istanbul, Zeytinburnu, 34015, Turkey (Türkiye)

Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

  • Adults aged between 18 and 65 years
  • Presence of chronic nonspecific low back pain lasting for at least 6 months
  • No signs or symptoms of radicular pain or progressive neurological deficit
  • No history of lumbar spine surgery
  • No manual therapy, spinal injection, or structured physiotherapy program for low back pain within the last 3 months
  • Ability to participate in a physiotherapy and exercise program
  • Willingness to participate in the study and provision of written informed consent

Exclusion criteria

  • Specific causes of low back pain (e.g., fracture, tumor, infection, inflammatory spinal disorders)
  • Presence of radiculopathy or severe neurological impairment
  • History of spinal surgery
  • Pregnancy
  • Severe balance, vestibular, or neurological disorders that may interfere with proprioception testing
  • Any medical condition contraindicating physical therapy or manual therapy
  • Participation in another clinical trial or receiving concurrent treatment for low back pain during the intervention period

Treatment and study plan

Conventional Physiotherap

Other

Participants in this arm received a standardized conventional physiotherapy program consisting of electrotherapy, thermal modalities, stretching exercises, and core stabilization exercises. The program was administered three times per week for six weeks.

Conventional Physiotherapy + Mulligan SNAG

Other

Participants in this arm received the same conventional physiotherapy program as the control group, combined with Mulligan Sustained Natural Apophyseal Glide (SNAG) techniques applied to the lumbar spine. SNAG techniques were performed by a physiotherapist during active pain-free movements, three times per week for six weeks.

Conventional Physiotherapy + Sham SNAG

Other

Participants in this arm received the standardized conventional physiotherapy program combined with sham SNAG applications. The sham procedure mimicked the positioning and therapist-patient interaction of the SNAG technique but without the application of therapeutic glide force. Interventions were administered three times per week for six weeks.

Primary outcomes

  1. Pain Intensity (VAS)

    Time frame: 6 weeks

    Pain intensity will be assessed using the Visual Analog Scale (VAS), a 10-cm horizontal line ranging from 0 (no pain) to 10 (worst imaginable pain). Participants will be asked to mark their perceived level of low back pain. Higher scores will indicate greater pain intensity.

Secondary outcomes

  1. Lumbar Proprioception (Joint Position Sense Error)

    Time frame: 6 weeks

    Lumbar proprioception will be assessed using a joint position sense (JPS) test. Participants will be asked to reproduce a predefined lumbar position, and the absolute difference between the target angle and the reproduced angle will be recorded as the repositioning error in degrees. Lower values will indicate better proprioceptive accuracy.

  2. Functional Performance (Five Times Sit-to-Stand Test)

    Time frame: 6 weeks

    Functional performance will be evaluated using the Five Times Sit-to-Stand (5xSTS) test. Participants will be instructed to stand up and sit down five times as quickly as possible from a standard chair without using their arms. The total time to complete the task will be recorded in seconds, with shorter times indicating better functional performance.

  3. Functional Disability (ODI)

    Time frame: 6 weeks

    Functional disability will be evaluated using the Oswestry Disability Index (ODI), which consists of 10 items assessing limitations related to low back pain. Each item is scored from 0 to 5, and the total score is expressed as a percentage, with higher scores indicating greater disability.

  4. Kinesiophobia (Tampa Scale of Kinesiophobia)

    Time frame: 6 weeks

    Kinesiophobia will be measured using the Tampa Scale of Kinesiophobia (TSK-17), a 17-item self-reported questionnaire scored on a 4-point Likert scale. Total scores range from 17 to 68, with higher scores indicating greater fear of movement and re-injury.

  5. Global Rating of Change (GRC)

    Time frame: At week 6 of the intervention

    Perceived overall change will be assessed using the Global Rating of Change (GRC) scale. Participants will be asked to rate their overall change in condition compared with baseline on a Likert-type scale ranging from -7 (very much worse) to +7 (very much better). Higher positive scores will indicate greater perceived improvement.

Sponsors and collaborators

Lead sponsor

Biruni University

Other

Registry information

Official study title

Effects of Mulligan SNAG Compared With Conventional and Sham Therapy in Chronic Nonspecific Low Back Pain

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Feb 17, 2026
Registry last updated
Mar 2, 2026

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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