Effect of Modified Lumbar Sustained Natural Apophyseal Glide on Low Back Pain in Postnatal Women
Keywords:
Modified lumbar Sustained Natural Apophyseal Glide, Postnatal Period, Low Back PainAbstract
Background: Postnatal low back pain (LBP) is identified as pain that begins shortly after childbirth. It is located above the gluteal folds and below the costal borders. LBP negatively impacts women's quality of life. Sustained Natural Apophyseal Glide (SNAG) technique can improve spinal ROM and decrease pain.
Purpose: To explore the efficacy of modified lumbar SNAG on postpartum LBP.
Methods: Sixty participants between the ages of 20 and 35 who had been experiencing LBP postnatally for at least three months and whose BMI was < 30 kg/m² were chosen from the Kasr El Ainy University Hospitals' outpatient clinics. They were distributed into two equal-number groups at random; the control group (A) (n=30) performed only traditional exercises (strengthening and stretching exercises for back and abdominal muscles) for 30 min/session, trice weekly for four weeks. Study group (B) (n=30) received Modified “SNAGs” on the affected lumbar level (L4-L5) for 10 sec for 3 sets/session, trice weekly for four weeks, plus the same exercise program as group (A). The two groups’ participants were assessed before and after treatment utilizing the visual analogue scale (VAS) to determine pain severity and the Oswestry Disability Index (ODI) to assess functional disability.
Results: The mean values of pain severity and functional disability in both groups decreased statistically significantly after treatment, with group (B) showing the greatest improvement.
Conclusion: The use of modified SNAGs was beneficial in treating postpartum LBP, and its integration with traditional exercises was more beneficial than traditional exercises alone.
Downloads
References
Sharma P. (2010): post-natal period: Midwifery and obstetrical nursing. Textbook. 1st Ed. Gennext Publication: India: Ch (5)p103.
Decherney AH, Nathan L, Laufer N and Roman AS. (2013): The normal puerperium: Current diagnosis and treatment: Obstetrics and gynecology. Genveo publisher: U.S.A, 11.th Ed: Ch10(4):190-191.
Wu WH, Meijer OG, Uegaki K, Mens JM, Van Diee¨n JH, Wuisman PI and O¨stgaard HC. (2004): Pregnancy-related pelvic girdle pain: Terminology, clinical presentation, and prevalence. European Spine Journal. 13(7):575-589.
Nilsson WL, Holm K, Oijerstedt R, and Harms RK. (2005): Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: A randomized clinical trial with 3, 6 and 12 months follow-up postpartum. Spine, 30(8):850-856.
Breen A, Real MTG, Hutchinson A, Koes B, Laerum E and Malmivaara A. (2006): European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J (15): 169–191.
Abbasi S, Hamid M, Ahmed Z and Nawaz FH. (2014): Prevalence of low back pain experienced after delivery with and without epidural analgesia: A non-randomised prospective direct and telephonic survey Indian J Anaesth. 58(2):143-148.
Weis CA, Barrett J, Tavares P, Draper C, Ngo K, Leung J, Huynh T and Landsman V. (2018): Prevalence of Low Back Pain, Pelvic Girdle Pain, and Combination Pain in a Pregnant Ontario Population. J Obstet Gynaecol Can;40(8):1038-1043.
To WWK and Wong MWN. (2003): Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy. Acta Obstet Gynecol Scand. 82(12):1086-91.
Shnayderman I and Katz-Leurer M. (2013): An aerobic walking program versus muscle strengthening Program for chronic low back pain: A randomized controlled trial. Clin. Rehabil. 27(3):207-214.
Chatzitheodorou D, Mavromoustakos S and Milioti S. (2008): The effect of exercise on adrenocortical responsiveness of patients with chronic low back pain, controlled for psychological strain. Clin. Rehabil. 22(4):319-328.
Kim JD, Oh HW, Lee JH, Cha JY, Ko IG and Jee YS. (2013): The effect of inversion traction on pain sensation, lumbar flexibility and trunk muscles strength in patients with chronic low back pain. Isokinet. Exerc. Sci. 21(3):237-246.
Masharawi Y and Nadaf N. (2013): The effect of non-weight bearing group-exercising on females with non-specific chronic low back pain: A randomized single blind controlled pilot study. J. Back Musculoskelet. Rehabil. 26(4):353-359.
Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J and Maher C. (2010): An updated overview of clinical guidelines for the management of non specific low back pain in primary care. Eur Spine J, 19(12):2075-2094.
Moutzouri M, Perry J and Billis E. (2012): Investigation of the effects of a centrally applied lumbar sustained natural apophyseal glide mobilization on lower limb sympathetic nervous system activity in asymptomatic subjects. J Manipulative Physiol Ther. 35(4):286-294.
Bialosky J, Bishop M, Price D, Robinson M and George S. (2009): Spinal Manipulative Therapy Has an Immediate Effect on Thermal Pain Sensitivity in People with Low Back Pain: A Randomized Controlled Trial. Physical Therapy. 89(12):1292-1303.
Doner G, Guven Z, Atalay A and Celiker R. (2013): Evaluation of Mulligan’s technique for adhesive capsulitis of the shoulder. Journal of rehabilitation medicine. 45(1):87-91.
Lopez-Lopez A, Alonso Perez JL, Gonzalez Gutierez JL, La Touche R, Lerma Lara S, Izquierdo H and Fernandez- Carnero J. (2015): Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial. Eur J Phys Rehabil Med; 51(2):121-32.
Hearn A and Rivett DA. (2002): Cervical SNAGs: a biomechanical analysis. Manual therapy. 7(2):71- 79.
Hussien HM, Abdel-Raoof NA, Kattabei OM and Ahmed HH. (2017): Effect of mulligan concept lumbar SNAG on chronic nonspecific low back pain. Journal of Chiropractic Medicine. 16(2):94-102.
Olaogun MOB, Adedoyin RA and Anifaloba RO. (2003): Reliability and concurrent validity of visual analogue scale and modified verbal rating scales of pain assessment in adult patients with knee osteoarthritis in Nigeria. S Afr J Physiother, 59(2):12-15.
Vianin M. (2008): Psychometric properties and clinical usefulness of the Oswestry Disability Index. Journal of chiropractic medicine. 7(4):161-163.
Tunji E, Oladebeye DH and Ibrahim A. (2020): Parametric Design of Height and Weight Measuring System. IJIREEICE. 8(7):22-34.
Kachanathu SJ, Alenazi AM, Seif HE, Hafez AR and Alroumim MA. (2014): Comparison between Kinesio Taping and a Traditional Physical Therapy Program in Treatment of Nonspecific Low Back Pain. J Phys Ther Sci. 26(8):1185-1188.
Youdas JW, Krause DA and Hollman JH. )2008(: Validity of hamstring muscle length assessment during the sit-and-reach test using an inclinometer to measure hip joint angle. J Strength Cond Res. 22(1):303-9.
Jari PA, Taru V, Markkuk and ölavi A. (2014): Activation at lumbar parsapinal and abdominal muscles during therapeutic exercises in chronic low back pain patients. Arch of Phy. Med. and Rehab. 85(5):823-823.
Huang Q, Li D, Yokotsuka N, Zhang Y, Ubukata H, Huo M and Maruyama H. (2013): The Intervention Effects of Different Treatment for Chronic Low Back Pain as Assessed by the Cross-sectional Area of the Multifidus Muscle. J Phys Ther Sci. Jul; 25(7):811–813.
Voight M, Hoogenboom B, and Prentice W. (2010): Musculoskeletal interventions: techniques for therapeutic exercise. Physiother Can. 62(2):166.
Tlapakova E, Jelen K and Minarikova M. (2011): The relationship between pelvis inclination, exercise and low back pain (LBP) during pregnancy. Acta Univ. Palacki. Olomuc. Gymn. 41(3):15-21.
Heggannavar A and Kale A. (2015): Immediate effect of modified lumbar snags in nonspecific chronic low back patients: a pilot study. Int J Physiother Res. 3(3):1018-23.
Van Middelkoop MV, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW and Van Tulder MW. (2011): A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. 20(1):19-39.
Russell R, Groves P, Taub N, O'Dowd J and Reynolds F. (2015): Assessing long term backache after childbirth. BMJ; 306(8):1299-303.
Frank AO and Souza LD. (2011): Conservative management of low back pain. Int J Clin Pract. 55(8):21–31.
Mannion AF, Müntener M and Taimela S. (2011): Comparison of three active therapies for chronic low back pain: results of a randomized clinical trial with one-year follow-up. Rheumatol, 40(10):77-778.
Gautam R, Kaur JD and Puri A. (2014): Comparison between Mulligan and Maitland mobilization in improving pain level, ROM and disability International. Journal of Physiotherapy and Research, Int J Physiother Res. 2(3):482- 87.
França FR, Burke TN, Caffaro RR, Ramos L and Pasqual A. (2012): Effects of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: a randomized, controlled trial. Journal of Manipulative and Physiological Therapeutics. 35(4):279-285.
Bentsen H, Lindgarde F and Manthorpe R. (2007): The effect of dynamic strength back exercise and/or a home training program in 57-year-old women with chronic low back pain. Results of a prospective randomized study with a3- years follow-up period. Spine. 22(13):1494-500.
Porterfield J and Derosa C. (2009): Mechanical low back pain, perspective in functional anatomy. 2 Ed, Philadelphia, Saunders. 53(119):185-186.
Bruno RC and Vieira ER. (2008): Stretching to reduce work-related musculoskeletal disorders: A systematic review. Journal of Rehabilitation Medicine. 40(9):321-328.
Schmid S, Wilson DA and Rankin CH. (2014): Habituation mechanisms and their importance for cognitive function. Front. Integr. Neurosci. 8(5):97.
Hidalgo B, Gobert F, Bragard D and Detrembleur C. (2013): Effects of proprioceptive disruption on lumbar spine repositioning error in a trunk forward bending task Journal of back and musculoskeletal rehabilitation. 26(8):381-387.
Paungmali A, Mphty, O'Leary S, Mphty, Souvlis T and Bill Vicenzino (2004): Naloxon fails to antagonize initial hypoalgesic effect of a manual therapy treatment of lateral epicondylalgia. Man Ther, 22(17):76-84.
Khalil TM, Asfour S, Martiner L, Maly S and Rosomff H. (2012): Stretching in the rehabilitation of low back pain patients. Spine. 17 (3):311-317.
Handa N, Yamamoto H, Tani T, Kawakami T and Takemasa R. (2010): The effect of trunk muscle exercises in patients over 40 years of age with chronic low back pain. J Orthop Sci. 5(3):210-216.
Amit K, Manish G and Taruna K. (2013): Effect of trunk muscles stabilization exercises and general exercises on pain in recurrent nonspecific low back ache. Int. Res. J. Med. Sci. 1(6):23-26.
Magnusson ML, Bishop JB, Hasselquist L and Spratt KF. (2018): Range of motion and motion pattern in patient with low back pain before and after rehabilitation. Spine. 23(23):2631-2639.
Sullivan M, Saraf L and Riddle D. (2010): The relationship of lumbar flexion to disability in patients with low back pain physical therapy. 80(3):240- 250.
Koumantakis GA, Watson PJ and Oldham JA. (2005): Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Phys Ther. 85(15):209-225.
Seo UH, Kim JH and Lee BH. (2020): Effects of Mulligan Mobilization and Low-Level Laser Therapy on Physical Disability, Pain, and Range of Motion in Patients with Chronic Low Back Pain: A Pilot Randomized Controlled Trial. Healthcare (Basel). 8(3):237.
Çirak Y, Yurdaişik I, Elbaşi ND, Tütüneken YE, Köçe K and Çinar B. (2021): Effect of sustained natural apophyseal glides on stiffness of lumbar stabilizer muscles in patients with nonspecific low back pain: randomized controlled trial. J Manipulative Physiol Ther. 44(6):445-454.
Bedard R, Lazenby T, Millspaugh R and Geisler P. (2009): Lumbar Facet Dysfunction & the Use of Mulligan’s SNAG Technique: A Case Report. Athletic Training Education Program. Sport Sciences. 9(5):20.
Hidalgo B, Pitance L, Hall T, Detrembleur C and Nielens H. (2015): Short-term effects of Mulligan mobilization with movement on pain, disability, and kinematic spinal movements in patients with nonspecific low back pain: A randomized placebo-controlled trial. J. Manip. Physiol. Ther. 38(16):365-374.
Jackson T, Wang Y, Wang Y and Fan HJ. (2014): Self-efficacy and chronic pain outcomes: a meta-analytic review. 15(8):800-14.
Frederikke BN. (2012): Effect of modified lumbar snag in lion on chronic non-specific low back pain for flexion deficits; University College Denmark, 6(10):82.
Petty NJ. (2013): The effect of posteroanterior mobilization on sagittal mobility of the lumbar spine. Man Ther, 1(7):25-9.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
