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176 Kikuchi et al. | Journal of Clinical and Translational Research 2024; 10(2): 172-179
Table 4. Other measurements immediately and 1 week after intervention
Intervention time Measurement Group Measurement
Mean±SD P‑value 95% CI Effect size Power (1–β)
Immediately after Right-side Thomas test Self-SNAGs 3.8±1.0 0.21 § −0.68, 0.52 0.82 0.55
Sham 4.5±1.7
Left-side Thomas test Self-SNAGs 4.0±1.5 0.93 § −1.17, 1.07 0.03 0.05
Sham 4.1±1.4
Right HBD Self-SNAGs 90.9±37.1 0.94 § −33.81, 31.38 0.05 0.05
Sham 92.1±46.3
Left HBD Self-SNAGs 91.5±41.9 0.97 § −35.07, 33.79 0.82 0.55
Sham 92.2±46.6
FFD Self-SNAGs −8.1±111.2 0.89 § −85.80, 75.04 0.03 0.05
Sham −2.7±95.2
Right SLR Self-SNAGs 68.7±6.3 0.43 N/A 0.05 0.05
Sham 67.1±6.1
One week after Right-side Thomas test Self-SNAGs 3.8±1.2 0.87 § −0.08, 0.47 0.92 0.65
Sham 3.8±1.3
Left-side Thomas test Self-SNAGs 4.2±1.3 0.91 § −1.16, 1.30 0.30 0.12
Sham 4.1±1.8
Right HBD Self-SNAGs 79.1±33.3 0.43 § −39.56, 17.46 0.02 0.05
Sham 90.1±39.8
Left HBD Self-SNAGs 82.9±37.7 0.64 § −37.02, 23.17 0.92 0.65
Sham 89.8±39.7
FFD Self-SNAGs 1.5±86.7 0.96 § −69.38, 65.62 0.30 0.12
Sham 3.4±87.1
Right SLR Self-SNAGs 68.1±4.6 0.53 § −2.61, 4.95 0.02 0.05
Sham 67.0±5.2
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; HBD: Heel-buttock distance; FFD: Finger-floor distance;
SLR: Straight leg raise test.
which could be attributed to the presence of pain [29]. Pain is studies. The self-SNAG procedure in this study was performed
likely to increase the muscle tone of the muscles around the spine in a standing position, while SNAGs were performed in a sitting
and pelvis which influences flexibility [30]. The effectiveness of position in previous studies, of which demonstrated positive
SNAG in improving flexibility and reducing pain is influenced effects [19-21,24-26]. The different effects between our study and
by the subject’s initial flexibility limitations and pain intensity. previous reports could also be associated with the force generated
In addition, the accuracy of the technique and the duration of the by an experienced therapist for SNAG versus a self-SNAG where
intervention may have an impact. It may be difficult to determine the the force relies on the lumbar self-SNAG strap (typically lesser
effect of treatment in patients with milder symptoms. Notably, it is than that applied by the therapist’s hands in a regular SNAG),
unclear whether SNAG practitioners are members of the Mulligan suggesting that self-SNAGs may be less effective in increasing
Concept Teacher Association or Certified Mulligan Practitioners, muscle flexibility of the lower limbs when compared to SNAGs and
or whether their skills in performing SNAGs are well established. warranting further investigation in a symptomatic population. Our
Furthermore, patients would display a poorer compliance rate study also demonstrated a carryover effect in left lateral bending
at longer intervention periods or when their symptoms started and left SLR. Although we did not examine the dominant arm in
to improve, thereby affecting the effectiveness of the study. The this study, we hypothesized that right-handed subjects tended to
elimination of pain through the SNAG technique, together with pull harder on the right strap, strongly affecting the left lumbar
repeated active movement, could explain the improvement in rotation and left SLR and resulting in longer-lasting effects.
muscle flexibility. In the absence of pain, repeated movement with This study also compared the effects of lumbar spine flexion,
or without the self-SNAG appears to have no beneficial effect on extension, right lateral flexion, right rotation, and left rotation
muscle flexibility. Despite our results indicating that self-SNAG ROM, and the Thomas test, FFD, and right SLR exhibited a
did not affect lumbar ROM and hip muscle flexibility, previous trend toward higher lumbar spine ROM or hip muscle flexibility
studies have suggested that it could alleviate pain. immediately after intervention. This study was based on a
Moreover, the lack of effect observed in this study could be crossover study in which manual therapy [31,32] and myofascial
attributed to the different positions used in previous SNAG release [33] were performed on LBP participants, and a 1-week
DOI: https://doi.org/10.36922/jctr.23.00091