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Kikuchi et al. | Journal of Clinical and Translational Research 2024; 10(2): 172-179 177
washout was established after no significant differences were Acknowledgments
observed. Hatano et al. [32] reported that the effect of 300 s of
static stretching was equivalent to 20 min of static stretching. None.
Therefore, it is suggested that regular stretching by a therapist Funding
and continued stretching are important to sustain the effects of
the intervention. However, LBP has a high incidence rate and None.
is expensive to treat [34], making it difficult for patients to visit Conflict of Interest
the clinic regularly. Nonetheless, the duration of treatment for
LBP can be shortened when the compliance rate of self-exercise The authors declare no competing interests.
is high [34]. However, in this study, the self-SNAGs and sham
groups displayed a decreasing trend in efficacy 1 week after the Ethics Approval and Consent to Participate
intervention compared to immediately after the intervention, even This study was conducted in accordance with the Declaration
though the compliance rate was 95% for both groups. This could be of Helsinki and was approved by the ethics committee at the
due to the fact that the self-exercise for evaluating the intervention Saitama Medical University (929). All participants agreed to sign
effects immediately after the intervention was performed under the an informed consent form.
supervision of the researchers, whereas the self-exercise for the
comparison of intervention effects 1 week after the intervention was Consent for Publication
performed at home and unsupervised. Nicolson et al. [35] reported All participants agreed to sign an informed consent form to use
that the correct implementation of the self-exercise overestimates their data for this study.
the intensity and frequency of the exercises. When performing self-
SNAGs at home, it is unclear whether the subject can apply the Availability of Data
belt in the correct position, pull the belt with the correct force, and
balance the left and right sides of the belt as instructed, and these Not applicable.
actions depend on the subject’s moderation. Therefore, it is necessary References
for the therapist to accurately set the intensity and number of times
when teaching self-exercise as it is difficult to precisely reproduce [1] Deyo RA, Cherkin D, Conrad D, Volinn E. Cost,
the self-exercise without proper instructions and guidance. Controversy, Crisis: Low Back Pain and the Health of the
Nonetheless, this study had several limitations. First, the Public. Annu Rev Public Health 1991;12:141-56.
asymptomatic adult male college students were in a narrow age doi: 10.1146/annurev.pu.12.050191.001041
range of 21.0 ± 0.8 years old, and future studies should investigate [2] Thiese MS, Hegmann KT, Wood EM, Garg A, Moore JS,
a population with a wider age range. Besides that, there could have Kapellusch J, et al. Prevalence of Low Back Pain by
been variations in the application and amount of force applied Anatomic Location and Intensity in an Occupational
by the participant when performing self-SNAG. Furthermore, Population. BMC Musculoskelet Disord 2014;15:283.
this study did not evaluate the alignment of the vertebral column doi: 10.1186/1471-2474-15-283
because the subjects were asymptomatic. The vertebral column [3] Boonen A, van den Heuvel R, van Tubergen A, Goossens M,
is involved in the balance of the hip bones in the sagittal plane Severens JL, van der Heijde D, et al. Large Differences
and should be assessed as well to better evaluate the effectiveness in Cost of Illness and Wellbeing between Patients with
of self-SNAG [36]. Finally, the sample size of this study was Fibromyalgia, Chronic Low Back Pain, or Ankylosing
calculated using G*Power 3.1.9.2 before the start of the study, Spondylitis. Ann Rheum Dis 2005;64:396-402.
and the sample size was 30 (α = 0.05; 1–β = 0.8; effect size = doi: 10.1136/ard.2003.019711
25
1.0778376). However, it became difficult to recruit participants for
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listed More than One Month Because of Low Back or
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Although SNAG is thought to alleviate pain and improve
movement, this study revealed that SNAG was not effective in doi: 10.1007/s00586-004-0731-3
the asymptomatic subjects of this study, as observed from the [5] Kim HS, Choi JW, Chang SH, Lee KS, Oh JY. Treatment
ROM and flexibility in the lower back and lower extremities. Duration and Cost of Work-related Low Back Pain in
To interpret the results of this study (i.e., low intervention effect Korea. J Korean Med Sci 2005;20:127-31.
on asymptomatic individuals), the low effect size should also be doi: 10.3346/jkms.2005.20.1.127
considered. Based on our present findings, we aim to investigate [6] Sung PS. A Kinematic analysis for Shoulder and Pelvis
the effects of self-SNAG on LBP and flexibility by implementing Coordination During Axial Trunk Rotation in Subjects
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DOI: https://doi.org/10.36922/jctr.23.00091