• The Journal of Korean Physical Therapy
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• 제25권1호
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• pp.10-15
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• 2013

Purpose: Low back pain occurs and frequently recurs in many people. An imbalance of paraspinal muscle activity can cause low back pain. Mulligan's concept of mobilizations with sustained natural apophyseal glides (SNAG) is a common method for treating low back pain. The purpose of this study was to investigate the effects of this method on paraspinal muscle activity in patients with chronic low back pain. Methods: Twenty-one patients with low back pain participated in this study. Patients were classified using the Oswestry disability index. The subjects' paraspinal muscles were measured by surface electromyography both before and after the SNAG mobilization. We measured the root mean square value of the paraspinal muscles during lumbar flexion and extension. Results: Paraspinal muscle activity in patients with chronic low back pain was different between the right and left sides. Importantly, paraspinal muscle activity significantly decreased after using the SNAG mobilization method. Conclusion: This study shows a difference between paraspinal muscle activity in chronic low back pain patients and finds that the Mulligan's concept of SNAG mobilization is effective at reducing imbalances in paraspinal muscle activity in low back pain patients.

• 대한정형도수물리치료학회지
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• 제27권2호
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• pp.9-15
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• 2021

Background: This study investigated the effects of sustained natural apophyseal glides (SNAGS) technique on lower back pain and pain disability among university students with lower back pain. Methods: A total thirty 20~30 year old university students with lower back pain were divided into two groups. A lumbar flexibility exercise was applied to the control group (n=15). The SNAGS technique group (n=15) received L1~L4 segment mobilization using SNAGS technique. Intervention was implemented for 20 minutes, 3 times a week for 3 weeks. The SNAGS were performed using belt with flexion and extension, whereas lumbar flexibility exercise included lumbar flexion and extension. Lower back disability was measured using the Korean Oswestry disability index (KODI), and pain sensitivity was measured by pain pressure threshold (PPT). The groups were assessed for lower back pain disability and pain, before and after the intervention. Results: There were significant improvements in both the KODI and PPT of the SNAGS technique group (p<.05), while the lumbar flexibility exercise group showed no significant change (p>.05). In addition, the SNAGS technique group had a statistically significant difference in KODI and PPT compared to the lumbar flexibility exercise group (p<.05). Conclusion: SNAGS technique is more effective than lumbar spine joint flexibility exercise in the improvement of lower back pain disability and pain among university students with lower back pain.

• 대한정형도수물리치료학회지
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• 제8권1호
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• pp.25-30
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• 2002

The main purpose of this article is to suggest a modified SNAGs manual method in based of Mulligan techniques. And this study aimed to resolve the back pain which has combined movement dysfunction in lumbar spine, in addition to upgrade of manual therapy technique in clinical field. The results of this study were as following; 1. The first introduction of SNAGs in Korea is the 'International Mulligan Concepts and Techniques Seminar' by Prof. Russell M. Woodman(Quinnipiac college, USA), 1998. SNAGs is defined a mobilization with movement manual therapy that facet joints of the lesion mobilized to anterior-superior direction according to the treatment plane in apophyseal joint of hypomobility. 2. A treatment mechanism of the SNAGs is, Mulligan say, HIVD which is the result of posterior disk bulging from a increased between intervertebral pressure due to hypo-mobile of facet joints in abnormal spine, so therapist should be necessary mobilization of zygophyseal joints especially in disk lesion. 3. Because Mulligan does not yet mentioned SNAGs techniques about a back pain with combined movements dysfunction, so we suggest a modified SNAGs method for manual therapy of back pain patients due to combined movement dysfunction at lumbar.

• 한국산학기술학회논문지
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• 제21권1호
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• pp.284-290
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• 2020

본 연구는 SNAGs(Sustained natural apophyseal glides)기법과 시각을 융합한 바이오피드백 훈련이 목 기능 장애 환자에게 고유수용성 감각과 목의 기능장애에 미치는 영향을 알아보고자 하였다. 목 기능장애 환자 31명을 대상으로 무작위로 SNAGs기법과 바이오피드백 훈련으로 할당하였으며, 관절위치 감각과 목 기능장애 평가를 중재 전-후 실시하였다. 16명의 SNAGs 중재그룹은 멀리건 벨트를 이용하여 굽힘, 폄, 회전을 실시하였고, 15명의 바이오피드백군은 시각적 피드백을 통한 깊은목 굽힘근 훈련을 실시하였다. 두 집단은 동일한 시간, 동일한 조건에서 20분 동안 주당 2회를 4주간 실시하였다. 바이오피드백 훈련 집단이 SNAGs 집단보다 고유수용성 감각에서 좌, 우 회전 모두 유의한 향상을 보였으며(p< 0.05), 목 기능장애는 SNAGs기법을 이용한 집단이 바이오피드백 훈련 집단보다 유의한 효과를 보였다(p<0.05). 따라서 SNAGs기법은 목의 기능제한 해결에 효과적이며, 바이오피드백 훈련은 고유수용성 감각 향상에 긍정적인 중재 방법이 될 것이다. 향후 목 통증 환자에 대한 연구를 진행시, 질환의 특성에 따라 중재방법을 선택 할 수 있을 것이다.

• 대한물리의학회지
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• 제2권2호
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• pp.113-124
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• 2007

Purpose : The purpose of this study was to investigate the effects of joint mobilization on the rang of motion and pain of patient with chronic low back pain. Methods : The subjects were consisted of thirty patients with chronic low back pain(19 females, 11 males ; mean aged 59.93) from 50 to 71. All subjects randomly assigned to the modalities treatment group, joint mobilization group. Modalities treatment group received hot pack used thermal therapy for 20minutes and ICT used electrical therapy for 15minutes, joint mobilization group received modalities treatment with sustained natural apophyseal glides(SNAGS) techniques of Mulligan for 10minutes per day and three times a week during 2 weeks period. Visual Analogue Scale(VAS) was used to measure subjective pain level. Remodified Schober test(RST) was used to measure range of motion of lumbar spine. All measurements of each patients were measured at pre-treatment and 2 weeks post-treatment. Results : The results of this study were summarized as follows : 1. VAS was joint mobilization group showed significantly decreased more than modalities treatment group (p<.05). 2. The lumbar flexion range of motion was joint mobilization group showed significantly decreased more than modalities treatment group(p<.05). 3. The lumbar extension range of motion was joint mobilization group showed significantly decreased more than modalities treatment group(p<.05). 4. The lumbar left lateral flexion range of motion was joint mobilization group showed significantly decreased more than modalities treatment group(p<.05). 5. The lumbar right lateral flexion range of motion was joint mobilization group showed significantly decreased more than modalities treatment group(p<.05). Conclusion : These data suggests that SNAGS of Mulligan is beneficial treatment for chronic low back pain.

• The Journal of Korean Physical Therapy
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• 제10권1호
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• pp.193-198
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• 1998

This study was introduce to Manual Therapy of Mulligan. The use of sustained natural apophyseal glides (SNAGS) and mobilisation with movement(MWM) for spine and peripheral joints has been developed by Mulligan. A mobilisation is applied parallel or right angles to restricted joint movement. If the applied mobilisation achieves immediate improvement in the functional movement and abolishes the pain the treatment involves sustaining the mobilisation while the patient performs the active movement repetitively. On reassessment of the joint function the movement should remain improved without the mobilisation. Theories as to why these techniques provide rapid improvement in pain-free range are proposed, and general principle of examination and treatment are outlined.

• 대한정형도수물리치료학회지
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• 제28권2호
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• pp.25-34
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• 2022

Background: Cervical headache (CGH) is a common condition that causes serious damage. Mulligan described a sustained natural apophyseal glides (SNAGs) as a manual therapy approach to treat this dysfunction. Although there have been several case studies to evaluate the effectiveness of SNAG, the efficacy of SNAG for cervical headaches is still controversial. Therefore, this study examined the effects of Mulligan's SNAG technique on cervical headache and pain intensity to present basic clinical data. Methods: Thirty-two subjects participated in this study, 16 each in the experimental and control groups. The experimental group applied Mulligan's SNAGs technique and the control group applied the placebo SNAGs technique. Results: Significant differences (p<.05) in the changes in pain, neck disability index (NDI) and Hamilton rating scale for depression (HRSD) were observed between the two groups. Conclusion: The application of Mulligan's SNAG technique to patients with cervical headaches effectively reduced headache, depression, and neck dysfunction. Based on this study, Mulligan's SNAGs technique can be used as an objective research method for additional studies targeting cervical headache patients in the future.

• 대한물리의학회지
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• 제3권3호
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• pp.203-213
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• 2008

Purpose : The purpose of the study was to investigate the effects of sustained natural appophyseal glides (SNAGS) on pain and lumbar stability in patients with chronic low back pain. Methods : The subjects were assigned randomly devided SNAGS group(n=18) and control group(n=18). The SNAGS group received Infrared(IR) used thermal therapy for 20minutes, Interference current therapy(ICT) used electrical therapy for 10minutes and SNAGS for 10minutes to 15minutes. The control group received IR used thermal therapy for 20minutes, ICT used electrical therapy for 10minutes and active stretching exercise for 10minutes to 15minutes. The visual analogue scale(VAS) and lumbar stability were measured at pre-treatment and post-treatment. Results : The results of this study were summarized as follows : 1. The VAS score of SNAGS group and control group was significantly within-subjects pre-test and post-test (p<.05), there was significantly difference between-subjects on each groups(p<.05). 2. The SNAGS group was significantly increased in variation of lumbar stability on $0^{\circ}$, $180^{\circ}$, $90^{\circ}$, $-90^{\circ}$, $45^{\circ}$, $-45^{\circ}$, $135^{\circ}$ and $-135^{\circ}$ within-subjects pre-test and post-test(p<.05), but The control group wasn't significantly increased in variation of lumbar stability on $0^{\circ}$, $180^{\circ}$, $90^{\circ}$, $-90^{\circ}$, $45^{\circ}$, $-45^{\circ}$, $135^{\circ}$ and $-135^{\circ}$ within-subjects pre-test and post-test(p>.05). There was significantly difference between-subjects on each groups(p<.05). Conclusion : In conclusion, SNAGS found that effective to decrease of pain and increase of lumbar stability. Therefore, the results of this study suggests that SNAGS is beneficial treatment for chronic low back pain.

• 대한정형도수물리치료학회지
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• 제14권2호
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• pp.68-77
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• 2008

Purpose : The purpose of this study was to investigate effects of movement with mobilization(MWM) and stabilization exercise on pain and range of motion of patients with acute low back pain. Methods : The subjects were consisted of 24 patients who had non specific acute low back pain. All subjects randomly assigned to the MWM group and the stabilization exercise group. The MWM group received sustained natural apophyseal glides(SNAGs) with modality treatment and stabilization exercise group received stabilization exercise with modality treatment. The remodified schober test(RST) was used to measure forward flexion and lateral flexion range of motion of lumbar segment. Visual Analogue Scale(VAS) was used to measure subjective pain level of the patients. The Oswestry Low Back Pain Disability Scale was used to measure functional disability level of the patients. Results : The lumbar flexion range of motion of MWM group was significantly increased compared with stabilization exercise group(p<.01). The range of motion of lumbar segment of MWM group was significantly decreased compared with stabilization exercise group(p<.01). The left lateral flexion range of motion of lumbar of MWM group was significantly decreased compared with stabilization exercise group(p<.05). The right lateral flexion range of motion of lumbar of MWM group was significantly decreased compared with stabilization exercise group(p<.05). The VAS of both MWM group and stabilization exercise group was significantly decreased(p<.001). The Oswestry Low Back Pain Disability Scale of stabilization exercise group was significantly increased compared with mobilization group(p<.001). Conclusion : In the result of this study, mobilization with movement and stabilization exercise had significant difference on pain and flexibility of patients with acute low back pain.