Effects of Mulligan SNAG in Chronic Nonspecific Low Back Pain

February 27, 2026 updated by: Begum Kara Kaya, Biruni University

Effects of Mulligan SNAG Compared With Conventional and Sham Therapy 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.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
30

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • Turkey (Türkiye)
    • Zeytinburnu
      • Istanbul, Zeytinburnu, Turkey (Türkiye), 34015
        • Biruni University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Conventional Physiotherapy
Other: Conventional Physiotherap
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.
Experimental: Conventional Physiotherapy + Mulligan SNAG
Other: Conventional Physiotherapy + Mulligan SNAG
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.
Sham Comparator: Conventional Physiotherapy + Sham SNAG
Other: Conventional Physiotherapy + Sham SNAG
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.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
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.
6 weeks

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
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.
6 weeks
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.
6 weeks
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.
6 weeks
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.
6 weeks
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.
At week 6 of the intervention

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Biruni University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
January 5, 2026

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
February 13, 2026

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
February 20, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
February 10, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 10, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
February 17, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
March 2, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 27, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
February 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • SNAG

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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