Effect of Two Different Mobilization Techniques in the Treatment of Low Back Pain

Effect of SNAG Versus Maitland Techniques in the Management of Non-Specific Low Back Pain

Non-specific low back pain (NSLBP) is extensively musculoskeletal conditions, where manual therapy techniques have been widely employed in its management, but their short term efficacy in chronic low back pain still need more investigations. Objective: This study aimed to discuss the SNAG versus Maitland techniques in the management of NSLBP. Methods: 60 patients with chronic NSLBP will share in the study. Sessions will be conducted 3 times per week for 4 weeks. The outcomes will be evaluated for pain by the numerical rating pain scale (NPRS), disability through Oswestry Disability Index, flexion range of motion by back range of motion device, postural stability by Biodex system will be assessed at baseline, immediately post-intervention, and at a four-week follow-up

Study Overview

• Status: Not yet recruiting
• Conditions: Non-specific Low Back Pain (NSLBP)
• Intervention / Treatment: Procedure: SNAG; Procedure: Maitland

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ehab Ahmed, PhD; Phone Number: +966564032363; Email: em.ahmed@uoh.edu.sa

Study Locations

• Saudi Arabia
  • Hail, Saudi Arabia, 0000
    • University Medical Clinics
    • Contact: Ehab Ahmed, Physiotherapist; Phone Number: +966564032363

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged 25 to 40 years.
• Diagnosed with chronic NSLBP persisting for more than three months.
• Pain intensity between 3 to 6 on the Visual Analog Scale (VAS) during lumbar extension in a sitting position.
• Oswestry Disability Index (ODI) score between 20% to 40%.
• Restriction of the movement only in flexion ROM with the ability to perform at least 40° of trunk flexion.

Exclusion Criteria:

• Specific causes of low back pain (e.g., herniated disc, spinal stenosis).
• History of spinal surgery or trauma.
• Neurological deficits or systemic diseases affecting the musculoskeletal system.
• Pregnancy.
• Current participation in other physiotherapy programs.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Maitland; Participants will receive Maitland technique therapy	Procedure: SNAG; The technique involves applying a sustained glide to the lumbar facet joints while the patient is in a sitting position, and the pelvic girdle will be stabilized by a belt. Then the therapist will ask the patient for active forward flexion of the spine while the pressure on the facet joint is maintained during the movement till its end; Other Names: sustained natural apophyseal glide; Procedure: Maitland; Maitland technique therapy, which consists of passive mobilizations applied to the lumbar facet joints in an anterocranial direction while the patient is in a prone lying position
Active Comparator: SNAG; Participants will receive SNAG therapy based on the Mulligan Concept	Procedure: SNAG; The technique involves applying a sustained glide to the lumbar facet joints while the patient is in a sitting position, and the pelvic girdle will be stabilized by a belt. Then the therapist will ask the patient for active forward flexion of the spine while the pressure on the facet joint is maintained during the movement till its end; Other Names: sustained natural apophyseal glide; Procedure: Maitland; Maitland technique therapy, which consists of passive mobilizations applied to the lumbar facet joints in an anterocranial direction while the patient is in a prone lying position

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale	The NPRS will be used to evaluate the level of pain by selecting a number on a rating scale, ranging from 0 (no pain) to 10 (worst and unbearable pain).	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lumbar flexion range of motion	Measured using a Back range of motion (BROM)	4 weeks
Functional disability	Assessed by the Oswestry Disability Index (ODI) where according to the scale the disability will be indicated as follow: 0-4 no disability, 5-14 mild disability, 5-24 moderate disability, 25-34 severe disability, and 35-50 complete disability	4 weeks
overall stability index (OSI)	Repositioning error evaluated through proprioceptive testing provided by the Biodex Balance System, no need for cut off) as the measurement differences will be compared.	4 weeks

Collaborators and Investigators

• Sponsor: Ehab Mohamed Kamel Ahmed
• Collaborators: The Scientific Research Deanship, University of Ha'il

Study record dates

Study Major Dates

• Study Start (Estimated): October 5, 2025
• Primary Completion (Estimated): December 30, 2025
• Study Completion (Estimated): January 20, 2026

Study Registration Dates

• First Submitted: September 9, 2025
• First Submitted That Met QC Criteria: September 9, 2025
• First Posted (Estimated): September 16, 2025

Study Record Updates

• Last Update Posted (Estimated): October 7, 2025
• Last Update Submitted That Met QC Criteria: October 2, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Other Study ID Numbers: H-2025-858

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: All the data will be obtained from the experiment is under the protection of the Scientific Research Deanship, University of Ha'il, Saudi Arabia as this project is funded from it with number RG-20 202.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No