Effects of Lumber Sustained Natural Apophyseal Glides on Lower Cross Syndrome

A sustained natural apophyseal glide (SNAG) is a mobilization technique commonly used in the treatment of painful movement restrictions of the spine.Studing the effect of Lumber SNAGs in lower cross syndrome hold significance due to its potential to correct pain, hypomobility and biomechanical changes i.e hyperlordotic curve and anterior pelvic tilting caused by lower cross syndrome. The specific muscle imbalance seen in PCS gives rise to specific joint dysfunction, particularly in the L4-L5 and L5-S1 segment of the vertebral column. Over time, this causes stress at the L5-S1 segment of the vertebral column leading to pain and irritation in the lower back Lumber SNAGs encourage improvement of these repositioning error, posture, alleviate discomfort and enhance overall functioning. This research aims to offer patients a noninvasive and personalized approach to managing LCS, ultimately contributing to their overall well-being and movement quality

Study Overview

• Status: Recruiting
• Conditions: Lower Cross Syndrome
• Intervention / Treatment: Other: lumber SNAGS; Other: Traditional Physical therapy

Detailed Description

A sustained natural apophyseal glide (SNAG) is a mobilization technique commonly used in the treatment of painful movement restrictions of the spine.Studing the effect of Lumber SNAGs in lower cross syndrome hold significance due to its potential to correct pain, hypomobility and biomechanical changes i.e hyperlordotic curve and anterior pelvic tilting caused by lower cross syndrome. The specific muscle imbalance seen in PCS gives rise to specific joint dysfunction, particularly in the L4-L5 and L5-S1 segment of the vertebral column. Over time, this causes stress at the L5-S1 segment of the vertebral column leading to pain and irritation in the lower back Lumber SNAGs encourage improvement of these repositioning error, posture, eleviate discomfort and enhance overall functioning. This research aims to offer patients a noninvasive and personalized approach to managing LCS, ultimately contributing to their overall well-being and movement quality The significance of this study lies in it's potential to improve the health and wellbeing of adults have pain and hypomobility due to lower cross syndrome.By identifying an effective physical therapy intervention for correcting pain and hypomobility , this study provide valueable insight for clinicians in develping effective treatment strategies.

• Study Type: Interventional
• Enrollment (Estimated): 36
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Asmar Fatima, MS-OMPT; Phone Number: 03336195644; Email: asmar.fatima@riphah.edu.pk

Study Locations

• Pakistan
  • Azad Kashmir
    • Kotli, Azad Kashmir, Pakistan, 0001
      • Recruiting
      • Orthopaedic hospital
      • Contact: Asmar Fatima, MS-OMPT; Phone Number: 03336195644; Email: asmar.fatima@riphah.edu.pk
      • Contact: Amreen Shabbir, MS_OMPT*; Phone Number: 92 345 5417467; Email: zainabamreen06@gmail.com
      • Principal Investigator: Amreen Shabbir
      • Sub-Investigator: Asmar Fatima

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 30 to 50 years.
• Both genders
• Patient came with the complain of low back pain.
• Participants had to present with pain and hypomobility due to lower cross syndrome
• Participants had to meet the criteria for lower cross syndrome indicating tight hip flexors and erector spinae along with weak abdominals and glutei muscles
• Participants with hyperlordotic curve due to lower cross syndrome
• Participants presenting with anterior pelvic tilting greater than angle >7-10 degrees
• Willing to provide informed consent to participate in study

Exclusion Criteria:Participants contraindicated to spinal manipulation

• Musculoskeletal pathologies affecting the lower back, pelvis, hips, or lower extremities (e.g., herniated disc, lumbar radiculopathy, lumbar stenosis, hip labral tear).
• Participants who had undergone any lumber or pelvic surgery, as it will affect sacroiliac joint mechanics.
• Generalized inflammatory or infective connective tissue disorder
• Pregnancy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: lumber SNAGS; A sustained natural apophyseal glide (SNAG) is a mobilization technique commonly used in the treatment of painful movement restrictions of the spine.Studing the effect of Lumber SNAGs in lower cross syndrome hold significance due to its potential to correct pain, hypomobility and biomechanical changes i.e hyperlordotic curve and anterior pelvic tilting caused by lower cross syndrome	Other: lumber SNAGS; : Lumber mobilizations with conventional treatment protocol.; Lumber Mulligan(SNAGs) technique; Technique applied at L4-L5, L5-S1 level.; Techniques applied for flexion ,extension, side bending and rotation 6 to 8 cycles per session
Other: Conventional group; Exercises ,Tens and hotpack	Other: Traditional Physical therapy; Conventional treatment protocol including moist Heating pad for low back pain for 15 minutes. TENS for pain for 10 minutes. Stretchings of tight muscles would be 1 set of 5-7 reps with 5 sec. hold 3 times a week. Strengthing of weak muscles would be 2-3 times a weak with 10-15 reps.Stretching protocol will be followed for Iliopsoas and erector spinae muscles. Strengthening protocol will be followed for weak abdominals and Gluteus maximus muscles

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Oswestry disability index	The Oswestry Low Back Pain Disability Questionnaire is an adequate apparatus used to measure disability caused by low back pain in the general population. The questionnaire examines the level of disability in 10 everyday activities of daily living. Each item consist of 6 statements which are scored from 0 to 5. With 0 indicating the least disability and 5 the greatest then the total score is calculated as a percentage, with 0% indicating no disability and 100% indicating the highest level of disability.	from baseline to 4th week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric pain rating sacle	The Numerical Rating Scale (Appendix G) is one of the most commonly used tools to measure pain intensity in both clinical and research settings. The Numerical Rating Scale is an 11-point scale that consists of numbers from 0 to 10, 0 signifies "no pain" and 10 signifies "worst imaginable pain"	from baseline to 4th week
Lumber Range of motion	to test hypomobility in Lumber Spine with the help of Inclinometer	AT baseline and 3rd week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Asmar Fatima, MS OMPT, Riphah International University

Publications and helpful links

General Publications

• Ishida H, Hirose R, Watanabe S. Comparison of changes in the contraction of the lateral abdominal muscles between the abdominal drawing-in maneuver and breathe held at the maximum expiratory level. Man Ther. 2012 Oct;17(5):427-31. doi: 10.1016/j.math.2012.04.006. Epub 2012 May 16.
• Key J. The pelvic crossed syndromes: a reflection of imbalanced function in the myofascial envelope; a further exploration of Janda's work. J Bodyw Mov Ther. 2010 Jul;14(3):299-301. doi: 10.1016/j.jbmt.2010.01.008. Epub 2010 Mar 4.
• Chaitow L., DeLany J.W., (2002). Clinical application of neuromuscular techniques: the lower body: Churchill livingstone. (p.26,36)
• Puagprakong P, Kanjanasilanont A, Sornkaew K, Brady W. The Effects of Lower Crossed Syndrome on Upper Body Posture during Sitting in Female Office Workers. Muscles, Ligaments & Tendons Journal (MLTJ). 2022;12

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2024
• Primary Completion (Estimated): March 31, 2025
• Study Completion (Estimated): March 31, 2025

Study Registration Dates

• First Submitted: November 25, 2024
• First Submitted That Met QC Criteria: November 26, 2024
• First Posted (Actual): November 27, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 20, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: pain; lumber SNGS
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Syndrome
• Other Study ID Numbers: REC/MS-PT/01879 Amreen Shabbir

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