Immediate Effect of Modified Lumbar Snags in Non-Specific Chronic Low Back Patients: A Pilot Study

Abstract

Background: Non-specific low back pain is prevalent in 23% with an incidence of 11-22% of general population. A modified lumbar SNAG is an existing Mulligan mobilization technique performed with a combination of joint glide and physiological spinal movement i.e. the lion exercise. Objective: To find out the immediate effect of modified lumbar SNAG on pain, range of motion and Back performance Scale in non-specific chronic low back patients. Methods: 30 subjects (mean age=36.9±10.07) were recruited for study. All patients received modified SNAG mobilization at the respective painful site followed by conventional therapy on the 1 st day. The outcome measures were assessed pre and post mobilization. The subjects were further treated with conventional therapy for 10 sessions. Outcome measures: Visual Analog Scale (VAS), Lumbar flexion ROM & Back performance scale. Results: Mean difference between pre and post treatment values for VAS, Lumbar flexion ROM and Back Performance Scale were 2.58±1.44, 0.26±0.19 and 4.4±1.71 respectively. All outcome measures were highly significant with p=0.0001. Conclusion: The results conclude that modified lumbar SNAG has an immediate effect on reducing pain and Back performance scale score and an improvement in lumbar flexion ROM.

Effect of Mulligan Concept Lumbar SNAG on Chronic Nonspecific Low Back Pain

“…49 Therefore, mobilizing the affected facet joints using SNAG could play a role in releasing strain on the capsule and improving the mobility of the joint, which influences the RE. 34 The reported improvement in VAS scores was previously reported by Hidalgo et al 25 and Heggannavar et al 26 This response could be attributed to multiple factors including the relief of the mechanical fault of the facet joint, which may allow easier and more pain-free movement.…”

“…10,25,26 It improved in 2 of them, 25,26 although in the third study, Konstantinou et al failed to report any significant change. 10 Pain was measured with a visual analog scale (VAS) in all studies and in the present study.…”

“…Range of motion was investigated in 4 out of the 5 studies. It was improved in 3 of them 10,25,26 ; no change was reported in the fourth trial by Moutzouri et al 21 The increase in ROM was reported only in the studies performed on LBP patients, and no improvement was reported when applied on healthy participants.…”

“…25,26 The Oswestry Disability Index (ODI) was used by Hidalgo et al, 25 whereas the back performance scale was used by Heggannavar et al 26 On both occasions patients reported better improvement in the level of function in response to SNAG.…”

“…21,26,35,36 Some of the available reports cannot be used for generalization because of the limitations encountered in the study design. 23,37 Therefore, the purpose of this study was to investigate the effect of adding Mulligan concept lumbar SNAG to a conventional LBP program on RE, pain, and function compared with a conventional LBP program alone in patients with chronic nonspecific LBP.…”