Chronic Low Back Pain (CLBP)NCT07215286
Comparative Study on SNAG From Different Positions Low Back Pain Treatment
A study testing Loaded-SNAG and Unloaded-SNAG in people with Chronic Low Back Pain (CLBP), run by University of Hail at 1 site in Saudi Arabia.
Trial summary
Objectives: To compare the effects of lumbar sustained natural apophyseal glides (SNAGs) applied in loaded versus unloaded positions on pain, disability, and function in individuals with chronic nonspecific LBP. Read more about this study
- Who is it for?
- Ages 20 to 40 years
- Conditions the study is for
- Chronic Low Back Pain (CLBP)
- What is being tested?
- Loaded-SNAG and Unloaded-SNAG
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 59 participants
- Where
- 1 siteSaudi Arabia
- Study dates
- 15 Oct 2025to 30 May 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Chronic non specific low back pain for 6 weeks or more
- Who scored between three and six on a visual analogue scale (VAS)
- Restriction of the movement was only in flexion ROM
Who cannot join
- Pregnancy,
- Obese,
- Infectious conditions of the spine,
- Autoimmune disorders,
- Malignancy
- Any contraindication to physiotherapy and manual therapy
- Any patient received physical therapy sessions last 6 months
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Comparative Study on SNAG From Loaded and Unloaded Position in the Treatment of Low Back Pain
Objectives: To compare the effects of lumbar sustained natural apophyseal glides (SNAGs) applied in loaded versus unloaded positions on pain, disability, and function in individuals with chronic nonspecific LBP.
Methods: A sample of 59 participants was assigned to receive six sessions of standard intervention, with lumbar SNAGs applied in either a loaded (sitting) or an unloaded (quadruped) position. This study was conducted between November 2025 and May 2026. Outcomes measured pre- and post-intervention included pain intensity (VAS), lumbar flexion range of motion (BROM device), and functional disability (Oswestry Disability Index).
Read the detailed description
Low back pain (LBP) is a global health problem with an estimated lifetime prevalence of up to 80% in adults [1]. It is one of the leading causes of disability worldwide and places a substantial burden on health care systems and economies. Although most cases are nonspecific, patients often experience significant pain, restricted mobility, and impaired function, which negatively affect their quality of life [2].
The global burden of low back pain remains substantial, particularly among middle-aged adults (45-59 years), with a disability-adjusted life years rate of 747.92 per 100,000 population in 2021. Notably, high body mass index was the only risk factor showing a significant increasing trend (estimated annual percentage change = 1.08) over the past three decades [3]. This epidemiological context underscores the clinical importance of our comparison, as loaded SNAGs may be particularly relevant for overweight/obese patients who experience greater gravitational loading on the lumbar spine during daily activities Management strategies typically involve a combination of exercise, patient education, and manual therapy [3]. Among manual therapy approaches, the Mulligan Concept - specifically, Sustained Natural Apophyseal Glides (SNAGs) - has gained attention due to its reported immediate effects on pain reduction and mobility.
SNAGs are a form of Mulligan concept mobilization-with-movement in which the therapist applies a sustained accessory glide to a spinal segment. At the same time, the patient actively performs the symptomatic movement. Evidence suggests SNAGs can improve pain, lumbar range of motion (ROM), and functional status in patients diagnosed with nonspecific LBP [4-6].
A central principle of SNAGs is their application in functional, weight-bearing positions that reflect real-life movement demands. However, physiotherapists sometimes apply SNAGs in unloaded positions (e.g., prone or quadruped) in both clinical settings and research situations. 9,10 Biomechanical research demonstrates that spinal loading alters facet joint kinematics and tissue stresses, suggesting that the clinical effect of SNAGs may depend on whether they are applied in a loaded or unloaded position [7, 8]. Despite this, no randomised controlled trials (RCTs) have directly compared these two SNAG modes.
This study aims to address this gap by comparing the clinical effectiveness of lumbar SNAGs applied in loaded versus unloaded positions on pain, ROM, and function in patients with chronic nonspecific LBP.
- Conditions
- Chronic Low Back Pain (CLBP)
- Being tested
- Loaded-SNAG, Unloaded-SNAG
- Keywords
- Manual therapy, Mobilization with Movement, Spine, Mulligan
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Loaded-SNAGProcedure or surgery
patients will receive SNAGs from standing (Loaded-SNAG), step-stance, or functional position that provokes symptoms. A specialized Mulligan belt was used around the patient's waist and the therapist's hips. The mobilizing force was applied parallel to the facet joint plane (cephalic direction) and over the spinous processes of the respective symptomatic spinal levels. The therapist's hand's ulnar aspect was used over the spinous process of the superior vertebra of the involved segment for flexion glide. The therapist applies accessory glide to targeted zygapophyseal level while the patient actively performs symptomatic movement (e.g., forward flexion), performing repetitions with the therapist maintaining the glide.
Unloaded-SNAGProcedure or surgery
patients will receive unloaded SNAG from quadruped position to reduce the axial loading. The therapist applies the equivalent accessory glide at the symptomatic spinal level while the patient performs the symptomatic movement (modified to be non-weight-bearing).
| Study group | Role | What they receive |
|---|---|---|
| Loaded-SNAG | Active comparator | SNAGs from standing position Receives: Procedure: Loaded-SNAG; Procedure: Unloaded-SNAG |
| Unloaded-SNAG | Active comparator | SNAG from quadruped position Receives: Procedure: Loaded-SNAG; Procedure: Unloaded-SNAG |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain intensity
Visual analogue scale (VAS), which is a 10-cm line, 0 denotes no pain and 10 the most intense agony.
Measured: 1 week
Lumbar flexion ROM
The BROM is an electronic goniometer that will be used to evaluate the range of motion for trunk flexion
Measured: 1 week
Secondary outcomes (1)
Functional disability
The functional level was assessed using a validated Arabic version of the Oswestry Disability Index (ODI). A total score will be calculated, the percentage of disability (score obtained divided by 50 and multiplied by 100) ranged from 0% (no disability) to 100% (complete disability).
Measured: 1 week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Oct 2025
- Study start15 Oct 2025
- Primary completion30 May 2026
- Study completion30 May 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Chronic Low Back Pain (CLBP)Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 59 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Hail
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Ehab Mohamed Kamel Ahmed, University of Hail
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07215286
- Sponsor's protocol ID
- H-2025-910
- Status last verified
- Sep 2026
- First submitted
- 2 Oct 2025
- Last updated
- 9 Sep 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: The project is supervised by university of Hail and all the data should be authorized through it
Study at a glance
From the registry record, last updated by the sponsor on 9 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Study on SNAG From Loaded and Unloaded Position in the Treatment of Low Back Pain
- ClinicalTrials.gov ID
- NCT07215286
- Acronym / sponsor ID
- H-2025-910
- Conditions
- Chronic Low Back Pain (CLBP)
- Keywords
- Manual therapy, Mobilization with Movement, Spine, Mulligan
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 59 participants (actual)
- Lead sponsor
- University of HailUniversity, hospital or other
- Study start
- 15 Oct 2025 (actual)
- Primary completion
- 30 May 2026 (actual)
- Study completion
- 30 May 2026 (actual)
- First posted
- 10 Oct 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Objectives: To compare the effects of lumbar sustained natural apophyseal glides (SNAGs) applied in loaded versus unloaded positions on pain, disability, and function in individuals with chronic nonspecific LBP.
Methods: A sample of 59 participants was assigned to receive six sessions of standard intervention, with lumbar SNAGs applied in either a loaded (sitting) or an unloaded (quadruped) position. This study was conducted between November 2025 and May 2026. Outcomes measured pre- and post-intervention included pain intensity (VAS), lumbar flexion range of motion (BROM device), and functional disability (Oswestry Disability Index).
Detailed description
Low back pain (LBP) is a global health problem with an estimated lifetime prevalence of up to 80% in adults [1]. It is one of the leading causes of disability worldwide and places a substantial burden on health care systems and economies. Although most cases are nonspecific, patients often experience significant pain, restricted mobility, and impaired function, which negatively affect their quality of life [2].
The global burden of low back pain remains substantial, particularly among middle-aged adults (45-59 years), with a disability-adjusted life years rate of 747.92 per 100,000 population in 2021. Notably, high body mass index was the only risk factor showing a significant increasing trend (estimated annual percentage change = 1.08) over the past three decades [3]. This epidemiological context underscores the clinical importance of our comparison, as loaded SNAGs may be particularly relevant for overweight/obese patients who experience greater gravitational loading on the lumbar spine during daily activities Management strategies typically involve a combination of exercise, patient education, and manual therapy [3]. Among manual therapy approaches, the Mulligan Concept - specifically, Sustained Natural Apophyseal Glides (SNAGs) - has gained attention due to its reported immediate effects on pain reduction and mobility.
SNAGs are a form of Mulligan concept mobilization-with-movement in which the therapist applies a sustained accessory glide to a spinal segment. At the same time, the patient actively performs the symptomatic movement. Evidence suggests SNAGs can improve pain, lumbar range of motion (ROM), and functional status in patients diagnosed with nonspecific LBP [4-6].
A central principle of SNAGs is their application in functional, weight-bearing positions that reflect real-life movement demands. However, physiotherapists sometimes apply SNAGs in unloaded positions (e.g., prone or quadruped) in both clinical settings and research situations. 9,10 Biomechanical research demonstrates that spinal loading alters facet joint kinematics and tissue stresses, suggesting that the clinical effect of SNAGs may depend on whether they are applied in a loaded or unloaded position [7, 8]. Despite this, no randomised controlled trials (RCTs) have directly compared these two SNAG modes.
This study aims to address this gap by comparing the clinical effectiveness of lumbar SNAGs applied in loaded versus unloaded positions on pain, ROM, and function in patients with chronic nonspecific LBP.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Loaded-SNAG | Active comparator | Procedure: Loaded-SNAG, Procedure: Unloaded-SNAGSNAGs from standing position |
| Unloaded-SNAG | Active comparator | Procedure: Loaded-SNAG, Procedure: Unloaded-SNAGSNAG from quadruped position |
Who may qualify
- Ages
- 20 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (3 listed)
- Chronic non specific low back pain for 6 weeks or more
- Who scored between three and six on a visual analogue scale (VAS)
- Restriction of the movement was only in flexion ROM
Key exclusion criteria (7 listed)
- Pregnancy,
- Obese,
- Infectious conditions of the spine,
- Autoimmune disorders,
- Malignancy
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Loaded-SNAGpatients will receive SNAGs from standing (Loaded-SNAG), step-stance, or functional position that provokes symptoms. A specialized Mulligan belt was used around the patient's waist and the therapist's hips. The mobilizing force was applied parallel to the facet joint plane (cephalic direction) and over the spinous processes of the respective symptomatic spinal levels. The therapist's hand's ulnar aspect was used over the spinous process of the superior vertebra of the involved segment for flexion glide. The therapist applies accessory glide to targeted zygapophyseal level while the patient actively performs symptomatic movement (e.g., forward flexion), performing repetitions with the therapist maintaining the glide. | Procedure or surgery | Loaded-SNAG, Unloaded-SNAG |
| Unloaded-SNAGpatients will receive unloaded SNAG from quadruped position to reduce the axial loading. The therapist applies the equivalent accessory glide at the symptomatic spinal level while the patient performs the symptomatic movement (modified to be non-weight-bearing). | Procedure or surgery | Loaded-SNAG, Unloaded-SNAG |
Primary outcome
Pain intensity
Time frame: 1 week
Visual analogue scale (VAS), which is a 10-cm line, 0 denotes no pain and 10 the most intense agony.
Lumbar flexion ROM
Time frame: 1 week
The BROM is an electronic goniometer that will be used to evaluate the range of motion for trunk flexion
1 secondary outcome
Functional disability
Time frame: 1 week
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 Sep 2026.
- Individual participant dataSharing planned: No. The project is supervised by university of Hail and all the data should be authorized through it
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Loaded-SNAG and Unloaded-SNAG in people with Chronic Low Back Pain (CLBP), run by University of Hail at 1 site in Saudi Arabia.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 9 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Saudi Arabia. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain intensity (time frame: 1 week). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Sep 2026.