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 Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
30
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.
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.
Biruni University
Istanbul, Zeytinburnu, Turkey (Türkiye)
RECRUITINGPain 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.
Time frame: 6 weeks
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.
Time frame: 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.
Time frame: 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.
Time frame: 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.
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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.
Time frame: 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.
Time frame: At week 6 of the intervention