What Is The Evidence For The Effectiveness Of Mulligan's Natural Apophyseal Glides (NAGs) And Sustained Natural Apophyseal Glides (SNAGs) For The Management Of Non-Specific Spinal Pain (NSSP)?

The purpose of this study was to conduct a systematic review of the literature to answer the research question: "What is the evidence for the effectiveness of Mulligan's natural apophyseal glides (NAGs) and sustained natural apophyseal glides (SNAGs) for the management on non-specific spinal pain (NSSP)?" A literature search was conducted for all study designs of all available dates using pre-determined search terms generated by The United States National Library of Medicine's Medical Subject Headings (MeSH) within 6 scientific databases: CINAHL, MEDLINE, PEDro, PubMed, SCOPUS and SPORTSDiscus. Five studies (2 RCTs, 3 case reports) met the pre-determined inclusion criteria for the systematic review and were subjected to subsequent critical analysis. All included studies except for one demonstrated improvements in outcomes related to pain intensity and/or range of movement following NAG or SNAG treatment. Various confounding variables limited the methodological strength of the included studies and a lack of investigation to the clinical significance of the results limited our confidence in their conclusions. There remains a paucity of high quality evidence to support the descriptive reports regarding the short-term benefits of NAGs and SNAGs on outcomes related to pain intensity and range of movement. Further RCTs are needed to support these descriptive reports regarding the benefits of this technique in the management of NSSP. Despite this, NAGs and SNAGs should be considered an adjunct treatment in the management of NSSP based on the clinical judgement of the therapist as well as patient preferences.msc_physpreunpub1675_ethesesunpu