title: The effects of the Mulligan Sustained Natural Apophyseal Glide (SNAG) mobilisation in the lumbar flexion range of asymptomatic subjects as measured by the Zebris CMS20 3-D motion analysis system.
abstract: BACKGROUND
  Mulligan's mobilisation techniques are thought to increase the range of movement (ROM) in patients with low back pain. The primary aim of this study was to investigate the application of the Mulligan's Sustained Natural Apophyseal Glide (SNAG) technique on lumbar flexion ROM. The secondary aim was to measure the intra- and inter-day reliability of lumbar ROM employing the same procedure.
  
  
  METHODS
  49 asymptomatic volunteers participated in this double-blinded study. Subjects were randomly assigned to receive either SNAG mobilisation (n = 25), or a sham mobilisation (n = 24). The SNAG technique was applied at the L3and L4 spinal levels with active flexion in sitting by an experienced manual therapist. Three sets of 10 repetitions at each of the two spinal levels were performed. The sham mobilisation was similar to the SNAG but did not apply the appropriate direction or force. Lumbar ROM was measured by a three dimensional electronic goniometer (Zebris CMS20), before and after each technique. For the reliability, five measurements in two different days (one week apart) were performed in 20 healthy subjects.
  
  
  RESULTS
  When both interventions were compared, independent t tests yielded no statistically significant results in ROM between groups (p = 0.673). Furthermore no significant within group differences were observed: SNAG (p = 0.842), sham (p = 0.169). Intra- and inter-day reliability of flexion measurements was high (ICC(1,1) > 0.82, SEM < 4.0 degrees , SDD<16.3%) indicating acceptable clinical applicability.
  
  
  CONCLUSIONS
  While the Zebris proved to be a reliable device for measuring lumbar flexion ROM, SNAG mobilisation did not demonstrate significant differences in flexion ROM when compared to sham mobilisation.
  
  
  BACKGROUND
  Current Controlled Trials NCT00678093.
authors.affiliation: Centre for Rehabilitation Science, ARC Epidemiology Unit, School of Translational Medicine-Epidemiology Research Group, University of Manchester, Stopford Building, 2nd Floor, Oxford Road, Manchester, M13 9PT, UK. moutzouri_marie@yahoo.com
authors.forename: Maria
authors.initials: M
authors.lastname: Moutzouri
authors.forename: Evdokia
authors.initials: E
authors.lastname: Billis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Strimpakos
authors.forename: Polixeni
authors.initials: P
authors.lastname: Kottika
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Oldham
mesh_terms: D000293:Adolescent; D000328:Adult; D053587:Arthrometry, Articular / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D008297:Male; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D015203:Reproducibility of Results; D055815:Young Adult