• Journal of the Korean Society of Physical Medicine
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• v.2 no.2
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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 Academy of Orthopedic Manual Physical Therapy
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• v.8 no.1
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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.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.27 no.2
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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.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.351-357
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• 2023

This Study Rreceived Subjective Evaluation ROC Evaluation from five projection. of projection. at a University Hospital to Obtain and Diagnose Sharp images of apophyseal joints and Vertral arch of Thoracic vertebrae from thoracic X-ray projection. In the Subjective evaluation, the highest Score was obtained by raising the phantom from Supine to LAO by 70° and scoring 20 points at 5° with the X-ray Tube facing the head. In addition, he scored the highest score of 19 points at 8° with the Prone Phantom standing 60° with RAO and the X-ray Tube facing the head. For Objective Evaluation, the Signal-to-noise ratio, was calculated. ROI was set at 1,564 mm2 to obtain the image signal average value (Mean value) and the Standard deviation (SD value). Objective Evaluation The signal-to-noise ratio, was the highest at 5° toward the head in the LPO 70° position of the phantom in the lying position of the Thoracic spine projection, and the Thoracic Spine was the highest at 8° toward the head of the RAO posture of 5,645.

• The Journal of Korean Physical Therapy
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• v.10 no.1
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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.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.1
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• pp.284-290
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• 2020

This study was undertaken to determine the effects of SNAGs (sustained natural apophyseal glides) and visual convergence biofeedback on the proprioception and neck disability of patients with chronic neck dysfunction. A total of 31 patients with neck dysfunction were assigned to either SNAGs (n = 16) or biofeedback (n = 15). The groups were assessed for proprioception and neck disability, before and after the intervention. The SNAGs were performed using belt with flexion, extension and right-left rotation, whereas biofeedback training included visual feedback training with deep neck flexor. Intervention was implemented for 20 minutes, twice a week for 4 weeks. Biofeedback training a showed significant effect on the joint position sense (left and right rotation) as compared to the SNAGs group (p< 0.05), whereas neck disability index was significantly effective for SNAGs (p< 0.05). Ed. Notes: The previous statement lacked clarity. I have suggested the edit as per my understanding. Please review and revise appropriately, if required. Therefore, the SNAGs technique is effective for neck function, and biofeedback training is a positive intervention method for enhancing the proprioceptive sensation. In future studies on patients with neck pain, it may be possible to select an intervention method based on the characteristics of the disease.

• The Korean Journal of Nuclear Medicine
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• v.25 no.1
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• pp.87-94
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• 1991

To evaluate the diagnostic usefulness of quantitative sacroiliac joint scintigraphy and its clinical significance in the ankylosing spondylitis, we measured SIS ratio (Sacroiliac Joint/Sacrum Uptake ratio) by region of interest method in 52 patients with ankylosing spondylitis. As compared with radiological grade, SIS ratio was significantly elevated in the early stage of ankylosing spondylitis and returned to normal range in the late stage. Scintigraphic finding of focal uptakes of radiotracer at multiple spinal apophyseal joints was characteristic and proximal large joints were more involved than distal joints. The incidence and extent of the arthropathy revealed by scnitigraphy exceeded that which was clinically evident, and scintigraphy was more sensitive to detect symptomatic lesion than radiography. Therefore, it is suggested that bone scan is useful for the early diagnosis and the assessment of clinical activity of involved joints of ankylosing spondylitis.

• Journal of the Korean Society of Radiology
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• v.18 no.4
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• pp.345-353
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• 2024

The purpose of this study was to suggest an appropriate collimation size and central X-ray incidence point by analyzing the correlation between the collimation size used in lumbar lateral examination and factors affecting the collimation size. the lumbar lateral examination results of 148 patients suitable for the purpose of this study were analyzed. The measurement method was to set the total horizontal width shown in the image to the size of the irradiation field(collimation) used during the examination. The distance connected vertically from the end of the dorsal field to the apophyseal joint of the third lumbar vertebra(AJD), the distance from the dorsal end of the image field to the center of the body of the third lumbar vertebra(BD), and the distance from the end of the dorsal field of the image to the center of the pedicle of the third lumbar vertebra(PD). The distance was measured. For comparative analysis of the mean values of dependent variables according to gender, age, height, weight, and body mass index, the mean values were compared using the independent samples t test and one-way ANOVA. For post hoc analysis, duncan was used. The correlation between independent and dependent variables was analyzed using Pearson correlation analysis. In this study, statistical significance was set at a p value of 0.05 or lower. The average value of the collimation size during the lumbar spine lateral examination was 252.45 mm, AJD was 102.11 mm, BD was 141.17 mm, and PD was 119.73 mm. The mean values of collimation size, AJD, BD, and PD were larger in men than in women, but statistical significance for the difference in mean values by gender was found only in BD (p<0.05). There was a slight difference in the mean value of each group according to age, but there was no statistical significance (p>0.05). The collimation size and mean values of AJD, BD, and PD according to height, weight, and body mass index differed depending on the independent variables, and the differences were all statistically significant (p<0.05). As a result of the correlation analysis, field size and AJD, BD, and PD showed no correlation with gender and age, a weak positive correlation with height, and a medium positive correlation with weight and body mass index. The results of this study showed that CS was correlated with height, weight, and BMI during lumbar lateral examination. If the entrance point of the central X-ray is moved to the appophyseal joint by considering weight and BMI when adjusting the collimation size in clinical practice, it is expected that the collimation size can be reduced bu about 5%.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.1
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• pp.43-48
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• 2002

Purpose : We evaluated radiographic changes and clinical manifestations of the elbow joint to identify the effects of the throwing between dominant and non-dominant arms. Materials and Methods : A hundred and five little leaguer’s baseball player in 5 elementary school and 2 middle school were evaluated for clinical symptoms and radiographic changes about elbow joint. Mean age was 12 years old and average periods of exercise were 32 months. Elbow functions were evaluated using ASES standardized assessment form and radiographic changes of medial epicondyle were examinated for enlargement, separation of the apophyses, fragmentation and irregularity. Results : Thirty seven players (35$\%$) were complained pain with throwing and the average score was 4.8 using visual analog scale. There were no significant differences in range of motion except flexion angle, valgus angle, and strength between dominant arm and non-dominant arm. Valgus laxity was more prominent in dominant arm. Ulnohumeral tenderness, radiocapitellar tenderness and medial flexor origin tenderness were in 18, 6, and 17 cases respectively in dominant arm. Medial epicondyle was enlarged in dominant arm with 13.0 by 6.3 mm compared to non-dominant arm with 11.7 by 6.1 mm. Apophyseal separation was 0.8 mm in dominant arm and 0.5 mm in non-dominant arm. Fragmentation and irregularity were 14 (13$\%$) and 25 (24$\%$) cases respectively in dominant arm. Conclusion : In little league baseball player, it needs usage of ball and bat with appropriate weight, and careful conditioning programs through throwing exercise in order to avoid elbow injuries.