Natural apophyseal glides

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Natural apophyseal glides (NAGS) refers to a spinal physical therapy treatment technique developed by Brian Mulligan.[1]


NAGS involves a mid to end-range facet joint mobilisation applied anterocranially along the plane of treatment within the desired joint, combined with a small amount of manual traction. The purpose of this treatment is to increase movement within the spine, and decrease symptomatic pain.[1]

Sustained natural apophyseal glides[edit]

Sustained natural apophyseal glides (SNAGS) are a separate technique involving a combination of a sustained facet glide with active motion, which is then followed by overpressure.[1]

Clinical evidence[edit]

A 2010 study concluded that whilst both NAGS and SNAGS showed signs of effectiveness, SNAGS demonstrated greater statistically significant efficacy over NAGS in reducing pain and disability in subjects with chronic neck pain.[2] Another study suggested that Mulligan's mobilisation (i.e. NAGS and SNAGS), Maitland's mobilisation and the McKenzie approach were all effective in relieving pain and improving range of motion in cases of chronic cervical spondylosis with unilateral radiculopathy.[3]

A 2008 randomised controlled trial by Reid et al. suggested a statistically significant correlation between SNAGS treatment and reduced dizziness, cervical pain and disability caused by cervical dysfunction,[4] whilst another randomised controlled trial in 2007 by Hall et al. suggested that a self-sustained C1-C2 SNAG technique was effective in managing cervicogenic headache.[5] A 2008 study by Moutzouri et al. suggested that SNAG mobilisation did not demonstrate significant effectiveness to increase the range of motion in patients with low back pain.[6]


  1. ^ a b c Brian R. Mulligan (2004). Manual therapy: NAGS, SNAGS, MWMS etc. (5th Ed). Plane View Services Ltd. ISBN 9780476011540
  2. ^ Nikeeta P. (2010). Comparative effectiveness of natural appophyseal glides and suatained natural apophyseal glides in chronic neck pain – A randomized clinical trial. KLE University, Belgaum, Karnataka.
  3. ^ Kulkarni, S. (2010). Comparative Effectiveness Of Three Manual Therapy Techniques In Chronic Cervical Spondylosis With Unilateral Radiculopathy-A Randomized Clinical Trial. KLE University, Belgaum, Karnataka.
  4. ^ Susan A. Reid, Darren A. Rivett, Michael G. Katekar, Robin Callister (2008). Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness, Manual Therapy, Volume 13, Issue 4, pp.357-366. doi:10.1016/j.math.2007.03.006
  5. ^ Hall, T., Chan, H. T., Christensen, L., Odenthal, B., Wells, C., & Robinson, K. (2007). Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. Journal of Orthopaedic and Sports Physical Therapy, 37(3), 100.
  6. ^ Moutzouri, M., Billis, E., Strimpakos, N., Kottika, P., & Oldham, J. A. (2008). The effects of the Mulligan Sustained Natural Apophyseal Glide (SNAG) mobilisation in the lumbar flexion range of asymptomatic subjects as measured by the Zebris CMS20 3-D motion analysis system. BMC Musculoskeletal disorders, 9(1), 131.

See also[edit]