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Kikuchi et al. | Journal of Clinical and Translational Research 2024; 10(2): 172-179 175
4. Discussion For lumbar spine ROM (flexion, extension, right lateral
bending, and rotation), no intervention effect was observed either
The purpose of this study was to evaluate the effects of
self-SNAGs compared to conventional repeated movements immediately or 1 week after the intervention. Although no studies
have previously investigated the effects of self-SNAGS, studies on
(i.e., trunk flexion) on the lumbar spine ROM and hip muscle the effects of lumbar SNAGs in asymptomatic participants have also
flexibility both immediately and 1 week after intervention.
reported no significant differences in lumbar spine ROM [26]. Taken
together, both SNAG and self-SNAG do not affect the ROM of pain-
Table 2. Differences in the other measurements for Groups A and B free people, suggesting that SNAGs target pain through a different
between Phases I and II
Group Measurement Difference P‑value 95% CI mechanism instead of the lumbar ROM per se. In symptomatic
people with LBP, a pain-free mobilization force applied during the
A (n=4) Right-side Thomas test 0.6±0.8 0.26 † −7.00, 1.80 self-SNAG or SNAG procedure is thought to improve the gliding
Left-side Thomas test 0.2±0.9 0.52 † −0.47, 0.85 property of the facet joints [19], thereby reducing pain and the fear
Right HBD −0.1±0.4 0.97 † −0.71, 0.69 of movement during exercise. Since the participants of this study
Left HBD 0.1±1.5 0.86 † −0.96, 1.13 were asymptomatic, the lumbar ROM was not restricted by pain and
FFD −4.0±13.8 0.60 † −25.98, 17.98 could only improve through changes in the viscoelastic properties
Right SLR −7.8±21.5 0.28 † −23.23, 7.57 of the joints and soft tissue. However, there were no significant
Left SLR −7.0±15.4 0.43 † −31.58, 17.58 differences between the sham and self-SNAG procedures.
B Right-side Thomas test −10.5±19.7 0.13 † −24.53, 3.60 Similarly, there were no changes to muscle flexibility around
(n=10) Left-side Thomas test −55.8±112.5 0.39 † −234.83, 123.16 the trunk and pelvis following the application of self-SNAGs. The
Right HBD −15.9±26.3 0.88 † −34.72, 2.92 Thomas test, HBD, FFD, and right SLR reported no intervention
Left HBD 70.9±10.3 0.14 ‡ N/A effect both immediately and 1 week after the intervention. In
FFD 66.6±6.5 0.80 ‡ N/A a previous study, SNAGs were performed on the lumbar spine
Right SLR 71.6±11.8 0.07 ‡ N/A of LBP participants in combination with trunk flexion, and the
Left SLR 67.0±10.1 0.05 ‡ N/A findings revealed improvements in the flexibility of the back and
Note: P-value was determined via student’s t-test; P-value was determined via Wilcoxon hip muscles [22]. In addition, the stiffness of the multifidus and
†
‡
rank sum test. erector spinae muscles (after SNAGs) was measured using shear
Abbreviations: CI: Confidence interval; HBD: Heel-buttock distance; FFD: Finger-floor
distance; SLR: Straight leg raise test; N/A: Not applicable. wave elastography and reported a decrease in muscle hardness,
Table 3. Lumbar spine range of motion measurements immediately and 1 week after intervention
Intervention time Measurement Group Lumbar spine range of motion
Mean±SD P‑value 95% CI Effect size Power (1–β)
Immediately after Flexion Self-SNAGs 10.5±3.0 0.66 § −3.17, 2.03 0.15 0.07
Sham 11.0±3.6
Extension Self-SNAGs 4.6±2.8 0.95 N/A 0.00 0.05
Sham 4.6±3.2
Right lateral Self-SNAGs 26.8±3.8 0.12 § −0.58, 5.01 0.62 0.35
bending Sham 24.6±3.3
Right rotation Self-SNAGs 8.6±2.6 0.25 § −0.92, 3.40 0.47 0.23
Sham 7.3±2.9
Left rotation Self-SNAGs 9.0±2.9 0.10 § −0.34, 3.96 0.65 0.38
Sham 7.2±2.6
One week after Flexion Self-SNAGs 9.6±2.7 0.50 § −3.50, 1.74 0.27 0.11
Sham 10.5±3.9
Extension Self-SNAGs 4.4±2.0 0.54 N/A 0.33 0.13
Sham 5.2±2.8
Right lateral Self-SNAGs 25.6±3.4 1.00 N/A 0.17 0.07
bending Sham 25.0±3.6
Right rotation Self-SNAGs 8.0±3.1 0.55 § −1.71, 3.14 0.26 0.10
Sham 7.2±3.1
Left rotation Self-SNAGs 8.4±2.4 0.30 § −1.00, 3.10 0.41 0.18
Sham 7.3±2.9
Note: P-value was determined via the unpaired t-test; P-value was determined via the Mann-Whitney U test.
§
Abbreviations: SD: Standard deviation; CI: Confidence interval; SNAGs: Sustained natural apophyseal glides; N/A: Not applicable.
DOI: https://doi.org/10.36922/jctr.23.00091