Effects of Mulligan SNAG in Chronic Nonspecific Low Back Pain

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: Completed
• Conditions: Pain; Physical Therapy; Nonspecific Chronic Low Back Pain; Manuel Therapy
• Intervention / Treatment: Other: Conventional Physiotherap; Other: Conventional Physiotherapy + Mulligan SNAG; Other: Conventional Physiotherapy + Sham SNAG

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

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

Participation Criteria

Eligibility Criteria

• 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

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

Outcome Measure	Measure Description	Time Frame
Pain Intensity (VAS)	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

Outcome Measure	Measure Description	Time Frame
Lumbar Proprioception (Joint Position Sense Error)	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)	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)	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)	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)	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

• Sponsor: Biruni University

Study record dates

Study Major Dates

• Study Start (Actual): January 5, 2026
• Primary Completion (Actual): February 13, 2026
• Study Completion (Actual): February 20, 2026

Study Registration Dates

• First Submitted: February 10, 2026
• First Submitted That Met QC Criteria: February 10, 2026
• First Posted (Actual): February 17, 2026

Study Record Updates

• Last Update Posted (Actual): March 2, 2026
• Last Update Submitted That Met QC Criteria: February 27, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain
• Other Study ID 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