Effect of Sustained Natural Apophyseal Glides on Stiffness of Lumbar Stabilizer Muscles in Patients With Nonspecific Low Back Pain: Randomized Controlled Trial

Objective: The aim of this study was to investigate the immediate effect of Mulligan sustained natural apophyseal glides (SNAGs) on muscular stiffness by using ultrasound shear wave elastography, pain, and function in patients with nonspecific low back pain. Methods: In a prospective, randomized, controlled, double-blinded study, 30 participants with nonspecific low back pain were randomly divided into 2 groups: a real SNAG group (aged 21.0 +/- 1.7, 5 men, 10 women) and sham SNAG group (aged 20.4 +/- 0.5, 4 men, 11 women). Muscular stiffness of the multifidus and erector spinal muscles with ultrasound shear wave elastography, visual analog scale, the sit and reach, flamingo balance, the functional reach, side bridge, and Biering-Sorensen tests were made before and immediately after intervention. The Oswestry Disability Index score was recorded only baseline. Results: After intervention, the change in visual analog scale, sit and reach, Biering-Sorensen, and side bridge tests scores were significantly different between real SNAG and sham SNAG groups (P < .05), but there was no significant difference in functional reach and flamingo balance test scores between the groups (P > .05). There was no significant difference for all measurements between pre- and post-intervention in sham SNAG group (P > .05). There was a significant reduction in muscular stiffness in the real SNAG group. But there was no change in muscular stiffness between pre-and postintervention in the sham group (P > .05). Conclusions: This study demonstrated that the Mulligan SNAG technique had a positive effect on pain severity, flexibility, trunk muscle endurance, and muscle stiffness in patients with nonspecific LBP.