Sciatica PainCASE-SNAGNCT07161323
SNAG and SNME in Non-Specific Sciatic Pain
A study testing Sustained Natural Apophyseal Glide (SNAG) and Sciatic Nerve Mobilization Exercises (SNME) in people with Sciatica Pain and Sciatica Acute, run by Istinye University at 1 site in Turkey (Türkiye).
Trial summary
This study is designed as a crossover trial. All participants who meet the inclusion criteria and voluntarily agree to participate will be evaluated using the assessment methods detailed below. Subsequently, participants will be randomly assigned into two groups. Read more about this study
- Who is it for?
- Ages 20 to 50 yearsHealthy volunteers can take part
- Conditions the study is for
- Sciatica Pain, Sciatica Acute, Mulligan Mobilization
- What is being tested?
- Sustained Natural Apophyseal Glide (SNAG) and Sciatic Nerve Mobilization Exercises (SNME)
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 30 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 Jul 2025to 1 Jul 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 50 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- Adults between the ages of 20 and 50,
- Individuals describing non-specific sciatic pain characterized by unilateral low back pain accompanied by radiating symptoms to the leg,
- Duration of pain longer than 12 weeks,
- Presence of pain during the Slump Test and Straight Leg Raise Test,
- No history of any physical therapy or intervention in the past month.
- b: Exclusion Criteria:
Show all 15Show fewer
- Individuals diagnosed with herniated disc or spinal stenosis by a physician,
- Physician-diagnosed secondary neurological conditions,
- History of spinal surgery,
- Individuals describing the origin of their pain as the lower back (without leg involvement),
- Presence of neurological symptoms (e.g., foot drop, significant muscle weakness),
- Serious medical conditions that may affect treatment or outcomes (e.g., cancer, infections, or inflammatory diseases),
- Pregnancy or recent childbirth (within the past year),
- Use of medications that may affect pain perception or mobility (e.g., opioids),
- Inability to comply with the weekly treatment schedule.
Who cannot join
None listed.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Sohiab Hassan Mohamed Wagdy Ahmed Elsayed Eladawi, Physiotherapist contact
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
Clam Fizyoterapi Merkezi
Istanbul
Enes Kaya
About this study
Official title: Comparison of the Acute Effects of Sustained Natural Apophyseal Glide and Sciatic Nerve Mobilization Exercises in Non-Specific Sciatic Nerve Pain
This study is designed as a crossover trial. All participants who meet the inclusion criteria and voluntarily agree to participate will be evaluated using the assessment methods detailed below. Subsequently, participants will be randomly assigned into two groups. The first group (Mulligan Concept Group - MCG) will receive the SNAG technique, while the second group (Neural Mobilization Group - NMG) will perform the Sciatic Nerve Mobilization Exercise (SNME). After the intervention, participants will be evaluated a second time. Ten days after this session, participants will be invited back. Those who were in the MCG group during the first session will be re-evaluated and then receive the SNGE intervention. Participants who were in the SNGE group during the first session will be re-evaluated and then receive the SNAG intervention. Following this second intervention, participants will be evaluated once again.
Assessments will be done are Demographic Form, Visual Analogue Scale, Oswestry Disability Index, Joint Range of Motion, Five-times Sit-to-stand Test, Sit and Reach Test
Read the detailed description
The sciatic nerve, formed by the union of five spinal nerve roots (L4, L5, S1, S2, and S3), is one of the largest and most important peripheral nerves, carrying both motor and sensory fibers. Due to its complex anatomical course and position, sciatic nerve pain is a common form of neuropathic pain. Despite its high prevalence, research on the effectiveness of non-pharmacological treatments remains limited, restricting the development of evidence-based clinical guidelines for primary care management. One such conservative approach is sciatic nerve mobilization, also known as neurodynamic techniques or nerve gliding exercises. Sciatic Nerve Mobilization Exercises (SNME) aim to facilitate gentle sliding of the sciatic nerve along its anatomical pathway without overstretching or irritating it, thereby reducing pain and improving function. On the other hand, the Mulligan Concept (MC) is a modern manual therapy approach incorporating sustained natural apophyseal glides (SNAGs), especially effective for spinal dysfunctions. These mobilizations are typically pain-free and performed in conjunction with active patient movement. SNAGs target the lumbar spine to restore joint mechanics and relieve pain. Widely adopted in clinical practice, this method is used by a significant number of physiotherapists in the UK and US, often as part of their routine patient care. While both SNME and SNAGs are commonly used for managing non-specific sciatic pain, direct comparisons of their clinical efficacy are scarce. Therefore, this study aims to fill that gap by evaluating and comparing the acute effects of these two interventions in individuals with non-specific sciatic nerve pain. The objectives are to determine which technique is more effective in reducing pain, enhancing functional mobility, and improving daily activity performance. The study also seeks to assess which intervention yields better outcomes in terms of range of motion, functional movement, and flexibility. The null hypothesis (H0) posits no significant difference between SNME and SNAGs in improving pain and function in patients with non-specific sciatic pain, whereas the alternative hypothesis (H1) suggests a significant difference between the two. This research holds clinical relevance in guiding physiotherapists toward evidence-based interventions tailored to the needs of individuals suffering from this widespread and disabling condition.
- Conditions
- Sciatica Pain, Sciatica Acute, Mulligan Mobilization
- Being tested
- Sustained Natural Apophyseal Glide (SNAG), Sciatic Nerve Mobilization Exercises (SNME)
- Keywords
- Sciatic Nerve Pain, Mulligan Concept, Manual Therapy, Pain Management, Non-Specific Sciatica
- Medical subject headings
- Agnosia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Sustained Natural Apophyseal Glide (SNAG)Other
In this intervention, participants will initially receive the SNAG technique targeting the L5-S1 lumbar segment. Participants will be seated on a treatment table with feet flat and knees at 90°. The therapist will position a specialized Mulligan belt around the L5-S1 segment and anchor it around their pelvis to generate a gentle traction force via controlled hip movement. While this force is applied, participants will perform active trunk flexion, holding the end-range position for 30 seconds. This movement will be repeated six times, constituting a 3-minute set. A total of 4 sets will be administered, with 2-minute rest periods between sets.
Sciatic Nerve Mobilization Exercises (SNME)Other
Participants will sit with hips and knees at 90° flexion, feet flat on the floor. The involved leg will be fully extended at the knee. In this position, the participant will be asked to perform ankle dorsiflexion and neck extension simultaneously (applying tension to the distal part of the sciatic nerve while relaxing the proximal part) and hold for 3 seconds. Next, the participant will plantarflex the ankle and flex the neck (tensioning the proximal end while relaxing the distal), again holding for 3 seconds. This 6-second sequence will be repeated 10 times per set. The exercise will be performed in 3 sets per leg, with 3-minute rests between sets.
| Study group | Role | What they receive |
|---|---|---|
| Mulligan Consept Group (MCG) | Experimental | Not described Receives: Other: Sustained Natural Apophyseal Glide (SNAG) |
| Neural Mobilization Group (NMG) | Experimental | Not described Receives: Other: Sciatic Nerve Mobilization Exercises (SNME) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Oswestry Disability Index (ODI)
The ODI assesses the impact of sciatic nerve pain on daily activities, including sitting, standing, walking, sleeping, and personal care. The total score indicates the level of disability.
Measured: Through study completion, an average of 1 year
5 Times Sit to Stand Test
The test will be used to measure the time it takes for an individual to rise from a seated position and sit back down. The participant is prepared in a seated position on a standard chair with a height of 43-46 cm, with their back against the chair and arms crossed over the chest. Upon the command to begin, the participant stands up fully and then completes the test by sitting down and standing up a total of five times as quickly as possible.
Measured: Through study completion, an average of 1 year
Sit and Reach Test
The participant will sit on a mat placed on a flat surface, with legs extended straight forward and knees fully extended. The soles of the feet will be positioned vertically and kept stable. The participant will then reach forward with both arms, aiming to touch the toes or reach beyond them if possible. The reach distance will be recorded in centimeters based on how far the fingertips are from the soles of the feet.
Measured: Through study completion, an average of 1 year
Secondary outcomes (2)
Range of Motion
Spinal flexion, extension, and lateral flexion range of motion (ROM) will be assessed using a goniometer. The patient will be prepared in an upright standing position, with feet shoulder-width apart, arms relaxed at the sides, and maintaining a straight posture. Then the function will be done by the patient actively.
Measured: Through study completion, an average of 1 year
Pain Intensity Visual Analog Scale (VAS)
Pain intensity will be evaluated using the Visual Analog Scale (VAS), where participants rate their pain from 0 (no pain) to 10 (worst imaginable pain). Pain will be measured during sitting, forward bending, and walking, for both back and leg pain.
Measured: Through study completion, an average of 1 year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Sep 2025
- Study start1 Jul 2025
- Primary completion1 Jul 2026 (estimated)
- Study completion1 Jul 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Sciatica PainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind
- Who is masked
- Investigator
- Enrolment
- 30 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Istinye University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Çiçek Günday, Istinye University
- Investigators
- Çiçek Günday, Asst.Prof., Principal investigator, Istinye UniversitySohiab Hassan Mohamed Wagdy Ahmed Elsayed Eladawi, Physiotherapist, Study chair, Istinye University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07161323
- Sponsor's protocol ID
- 28032025
- Acronym
- CASE-SNAG
- Status last verified
- Sep 2025
- First submitted
- 30 Jul 2025
- Last updated
- 8 Sep 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 8 Sep 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of the Acute Effects of Sustained Natural Apophyseal Glide and Sciatic Nerve Mobilization Exercises in Non-Specific Sciatic Nerve Pain
- ClinicalTrials.gov ID
- NCT07161323
- Acronym / sponsor ID
- CASE-SNAG / 28032025
- Conditions
- Sciatica Pain, Sciatica Acute, Mulligan Mobilization
- Keywords
- Sciatic Nerve Pain, Mulligan Concept, Manual Therapy, Pain Management, Non-Specific Sciatica
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 30 participants (estimated)
- Lead sponsor
- Istinye UniversityUniversity, hospital or other
- Study start
- 1 Jul 2025 (actual)
- Primary completion
- 1 Jul 2026 (estimated)
- Study completion
- 1 Jul 2026 (estimated)
- First posted
- 8 Sep 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study is designed as a crossover trial. All participants who meet the inclusion criteria and voluntarily agree to participate will be evaluated using the assessment methods detailed below. Subsequently, participants will be randomly assigned into two groups. The first group (Mulligan Concept Group - MCG) will receive the SNAG technique, while the second group (Neural Mobilization Group - NMG) will perform the Sciatic Nerve Mobilization Exercise (SNME). After the intervention, participants will be evaluated a second time. Ten days after this session, participants will be invited back. Those who were in the MCG group during the first session will be re-evaluated and then receive the SNGE intervention. Participants who were in the SNGE group during the first session will be re-evaluated and then receive the SNAG intervention. Following this second intervention, participants will be evaluated once again.
Assessments will be done are Demographic Form, Visual Analogue Scale, Oswestry Disability Index, Joint Range of Motion, Five-times Sit-to-stand Test, Sit and Reach Test
Detailed description
The sciatic nerve, formed by the union of five spinal nerve roots (L4, L5, S1, S2, and S3), is one of the largest and most important peripheral nerves, carrying both motor and sensory fibers. Due to its complex anatomical course and position, sciatic nerve pain is a common form of neuropathic pain. Despite its high prevalence, research on the effectiveness of non-pharmacological treatments remains limited, restricting the development of evidence-based clinical guidelines for primary care management. One such conservative approach is sciatic nerve mobilization, also known as neurodynamic techniques or nerve gliding exercises. Sciatic Nerve Mobilization Exercises (SNME) aim to facilitate gentle sliding of the sciatic nerve along its anatomical pathway without overstretching or irritating it, thereby reducing pain and improving function. On the other hand, the Mulligan Concept (MC) is a modern manual therapy approach incorporating sustained natural apophyseal glides (SNAGs), especially effective for spinal dysfunctions. These mobilizations are typically pain-free and performed in conjunction with active patient movement. SNAGs target the lumbar spine to restore joint mechanics and relieve pain. Widely adopted in clinical practice, this method is used by a significant number of physiotherapists in the UK and US, often as part of their routine patient care. While both SNME and SNAGs are commonly used for managing non-specific sciatic pain, direct comparisons of their clinical efficacy are scarce. Therefore, this study aims to fill that gap by evaluating and comparing the acute effects of these two interventions in individuals with non-specific sciatic nerve pain. The objectives are to determine which technique is more effective in reducing pain, enhancing functional mobility, and improving daily activity performance. The study also seeks to assess which intervention yields better outcomes in terms of range of motion, functional movement, and flexibility. The null hypothesis (H0) posits no significant difference between SNME and SNAGs in improving pain and function in patients with non-specific sciatic pain, whereas the alternative hypothesis (H1) suggests a significant difference between the two. This research holds clinical relevance in guiding physiotherapists toward evidence-based interventions tailored to the needs of individuals suffering from this widespread and disabling condition.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind (investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Mulligan Consept Group (MCG) | Experimental | Other: Sustained Natural Apophyseal Glide (SNAG) |
| Neural Mobilization Group (NMG) | Experimental | Other: Sciatic Nerve Mobilization Exercises (SNME) |
Who may qualify
- Ages
- 20 to 50 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (15 listed)
- Adults between the ages of 20 and 50,
- Individuals describing non-specific sciatic pain characterized by unilateral low back pain accompanied by radiating symptoms to the leg,
- Duration of pain longer than 12 weeks,
- Presence of pain during the Slump Test and Straight Leg Raise Test,
- No history of any physical therapy or intervention in the past month.
Key exclusion criteria (0 listed)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Sustained Natural Apophyseal Glide (SNAG)In this intervention, participants will initially receive the SNAG technique targeting the L5-S1 lumbar segment. Participants will be seated on a treatment table with feet flat and knees at 90°. The therapist will position a specialized Mulligan belt around the L5-S1 segment and anchor it around their pelvis to generate a gentle traction force via controlled hip movement. While this force is applied, participants will perform active trunk flexion, holding the end-range position for 30 seconds. This movement will be repeated six times, constituting a 3-minute set. A total of 4 sets will be administered, with 2-minute rest periods between sets. | Other | Mulligan Consept Group (MCG) |
| Sciatic Nerve Mobilization Exercises (SNME)Participants will sit with hips and knees at 90° flexion, feet flat on the floor. The involved leg will be fully extended at the knee. In this position, the participant will be asked to perform ankle dorsiflexion and neck extension simultaneously (applying tension to the distal part of the sciatic nerve while relaxing the proximal part) and hold for 3 seconds. Next, the participant will plantarflex the ankle and flex the neck (tensioning the proximal end while relaxing the distal), again holding for 3 seconds. This 6-second sequence will be repeated 10 times per set. The exercise will be performed in 3 sets per leg, with 3-minute rests between sets. | Other | Neural Mobilization Group (NMG) |
Primary outcome
Oswestry Disability Index (ODI)
Time frame: Through study completion, an average of 1 year
The ODI assesses the impact of sciatic nerve pain on daily activities, including sitting, standing, walking, sleeping, and personal care. The total score indicates the level of disability.
5 Times Sit to Stand Test
Time frame: Through study completion, an average of 1 year
The test will be used to measure the time it takes for an individual to rise from a seated position and sit back down. The participant is prepared in a seated position on a standard chair with a height of 43-46 cm, with their back against the chair and arms crossed over the chest. Upon the command to begin, the participant stands up fully and then completes the test by sitting down and standing up a total of five times as quickly as possible.
Sit and Reach Test
Time frame: Through study completion, an average of 1 year
The participant will sit on a mat placed on a flat surface, with legs extended straight forward and knees fully extended. The soles of the feet will be positioned vertically and kept stable. The participant will then reach forward with both arms, aiming to touch the toes or reach beyond them if possible. The reach distance will be recorded in centimeters based on how far the fingertips are from the soles of the feet.
2 secondary outcomes
Range of Motion
Time frame: Through study completion, an average of 1 year
Pain Intensity Visual Analog Scale (VAS)
Time frame: Through study completion, an average of 1 year
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Sep 2025.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Sohiab Hassan Mohamed Wagdy Ahmed Elsayed Eladawi, Physiotherapist contact
Çiçek Günday, Asst.Prof. principal investigator
Istinye University
Sohiab Hassan Mohamed Wagdy Ahmed Elsayed Eladawi, Physiotherapist study chair
Istinye University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Sustained Natural Apophyseal Glide (SNAG) and Sciatic Nerve Mobilization Exercises (SNME) in people with Sciatica Pain and Sciatica Acute, run by Istinye University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 15 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 8 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Sohiab Hassan Mohamed Wagdy Ahmed Elsayed Eladawi, Physiotherapist (+905415142895, sohiabhasan@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Oswestry Disability Index (ODI) (time frame: Through study completion, an average of 1 year). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Sep 2025; AzTrials last refreshed its copy on 30 Oct 2026.