Vertical Oscillatory Pressure and Sustained Natural Apophyseal Glides in ow Back Pain
Condition: Non Specific Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Among different spinal manual therapies, which have been reported to be effective in the
      management of LBP are Sustained Natural Apophyseal Glide (SNAGS) and Vertical Oscillatory
      Pressure (VOP) . Vertical oscillatory pressure is a derivative of manipulative therapy
      whereby a gentle vertical manipulative oscillation is applied on spinal vertebrae and has
      been noted to be effective in management of low back pain . On the contrary, the SNAGS is a
      manipulative technique that is commonly used in the western countries and found to be
      effective in reducing pain and disability in the management of mechanical LBP . However,
      there are limited studies comparing the effects of SNAG and VOP on clinical and psychosocial
      variables in patients with mechanical LBP in Nigeria. Hence, this study aims at investigating
      the effects of Nwugarian VOP and SNAG techniques on selected clinical and psychosocial
      variables in patients with mechanical LBP.
    

Detailed description: 
      Low back pain and the attendant disabilities have been on the increase in Africa and its
      burden is more in countries with longer life expectancy . The menace of the condition
      includes high level of disability, producing significant restrictions on usual activity and
      participation, such as ability to work . Contrary to general belief, LBP is not a problem
      that always resolves by itself, recurrences are usual and the course is varying in different
      circumstances . While emerging evidence and advocacy by Physiotherapy Associations favours
      active treatment for long-term LBP, however, spinal manipulation remains an important option
      for LBP that will or not resolve with active and self-care. Spinal manipulation has been
      reported to produce significant benefits within a short period , may be more and faster than
      expected improvements with active therapies . Further, while there is increasing advocacy for
      active management of LBP, many patients are not well suited or positioned to treat
      themselves, hence may require experts' management.

      Sustained Natural Apophyseal Glide (SNAGS) is a manipulative technique that is commonly used
      in the western countries and found to be effective in reducing pain and disability in the
      management of mechanical LBP . In another study by Shabana et al., on the comparative effect
      of SNAGS and Maitland's mobilization in chronic LBP, better improvement was observed in SNAGS
      group than in Maitland's. however, it is not commonly used in the Nigerian context. On the
      other hand, the Nwugarian technique; VOP, propunded by Nwuga is a home-grown spinal
      manipulation approach in Nigeria demonstrated the effectiveness of VOP on pain and disability
      in patients with mechanical lowback pain. VOP, in combination with lumbar stabilization
      exercises has also been noted to be more effective compared with VOP in isolation in the
      management chronic low back pain . Similarly, Egwu et al., concluded that VOP has significant
      effects on pain intensity and Lumbo-sacral mobility, and opined that VOP should be preferred
      as spinal mobilization therapy outcome measures in youths and elderly individuals with LBP.
      The effectiveness of VOP is hinged on few available studies. VOP requires pressure on the
      vertebral spinous process with oscillation by the therapist. The therapeutic mechanism of
      spinal manipulation have emphasized the importance of directing forces to specific spinal
      joints for the purpose of correcting a biomechanical dysfunction or misalignment . Studies
      have also shown and validated spinal manipulation to affect both sensory and motor nerve
      activity as well as electromyographic measured muscle activity . Outcome measures reflect the
      impact of the health care service or intervention on the health status of patients. To
      achieve comprehensive multidimensional evaluation of outcome in LBP ,one of the core outcome
      domains that must be considered is pain, the method of assessing has always been participants
      rating of improvement and satisfaction with treatment but not the effects of intervention at
      cellular level. Use of serum biomarkers has the potential to measure the effects of
      intervention at cellular level thereby helping to identify relevant treatment options and
      decrease the likelihood of failed interventions. However, effects of known treatment like VOP
      and SNAGS on the inflammatory status and bio cellular pain substance in patients with long
      term low-back pain has not been explored, ,hence this study This study is therefore aimed to
      investigate and compare the effect of VOP and SNAGS on pain-biomarkers, disability,
      flexibility and health-related quality of life in patients with mechanical LBP.
    

Intervention name(s): Vertical Oscillatory Pressure (VOP)
Intervention type(s): Other
Intervention description(s): The VOP involves a pressure from the posterior aspect of the body while patient lye prone. the pressure is exacted directly on the spine, The sustained Natural Apophyseal Glides involves pressure as well when the patient sits down on a chair. The movement is done from the posterior to the anterior as well
Other intervention name(s): Sustained Natural Apophyseal Glides (SNAGs)
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: There were two groups; Vertical Oscillatory and Sustained Natural Apophyseal group. Participants were allocated to each group randomly. Each group received intervention accordingly
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Low back pain,; Vertical Oscillatory Pressure,; Sustained Natural Apophzeal Glide,; Pain-Biomakers; Health Related Quality of Life