Research Paper: Immediate Effects of Maitland Mobilization and Mulligan Techniques on Flexion and Extension Range of Motion in Patients With Chronic Nonspecific Low Back Pain: A Randomized Pilot Study
Introduction: Nonspecific Chronic Low Back Pain (NSCLBP) is one of the most common musculoskeletal disorders among different societies. Manual therapists use different approaches for NSCLBP management and or treatment. Comparing manual techniques is a considerable controversial debate among treatment approaches. This study aimed at comparing the immediate effects following Maitland mobilization technique and Mulligan Sustained Natural Apophyseal Glide (SNAG) on flexion and extension in patients with the NSCLBP.
Materials and Methods: Eighteen volunteers with NSCLBP were randomly divided into three groups: Posteroanterior (PA) mobilization, SNAG, and Sham SNAG. The PA mobilization techniques (Grade III) were performed on prone lying position (four sets of four repetitions; last 30 seconds for each technique). The SNAG techniques were performed accompanying with active flexion in sitting position (four sets of six repetitions). The sham SNAG technique was applied in sitting position while therapist touched gently patients’ backs (three sets of four repetitions). Flexion and extension Range of Motions (ROMs) were measured before and immediately after applied interventions (by inclinometer).
Results: Within group analysis showed significant changes of flexion and extension in ROMs in SNAG and PA mobilization groups. Between groups analysis pointed out significant difference between the SNAG and placebo groups after interventions.
Conclusion: Our results revealed increased flexion ROM following the SNAG technique and increased extension ROM after Maitland PA mobilization. However, our limited sample size might influence final results. More studies with larger sample size will be suggested.
Papageorgiou AC, Croft PR, Ferry S, Jayson MI, Silman AJ. Estimating the prevalence of low back pain in the general population. Evidence from the South Manchester Back Pain Survey. Spine. 1995; 20(17):1889-94. doi: 10.1097/00007632-199509000-00009
Kent PM, Keating JL. The epidemiology of low back pain in primary care. Chiropractic & Osteopathy. 2005; 13:13. doi: 10.1186/1746-1340-13-13
Van Tulder M, Koes B, Bombardier C. Low back pain. Best Practice & Research Clinical Rheumatology. 2002; 16(5):761–75. doi: 10.1053/berh.2002.0267
Nachemson AL. Newest knowledge of low back pain. A critical look. Clinical Orthopaedics and Related Research. 1992; &NA(279):8-20. doi: 10.1097/00003086-199206000-00003
Mohseni-Bandpei MA, Fakhri M, Bargheri-Nesami M, Ahmad-Shirvani M, Khalilian AR, Shayesteh-Azar M. Occupational back pain in Iranian nurses: an epidemiological study. British Journal of Nursing. 2006; 15(17):914-7. doi: 10.12968/bjon.2006.15.17.21904
Mohseni-Bandpei MA, Fakhri M, Ahmad-Shirvani M, Bagheri-Nessami M, Khalilian AR, Shayesteh-Azar M, et al. Low back pain in 1,100 Iranian pregnant women: Prevalence and risk factors. The Spine Journal. 2009; 9(10):795-801. doi: 10.1016/j.spinee.2009.05.012
O’Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Manual Therapy. 2005; 10(4):242-55. doi: 10.1016/j.math.2005.07.001
Chou R. Low back pain. American family Physician. 2011; 84(4):437-438.
Wippert PM dWHJ, Klipker K, Gantz S, Schiltenwolf M, Mayer F. [Development and content of the behavioral therapy module of the MiSpEx intervention : Randomized, controlled trial on chronic nonspecific low back pain (German)]. 2015; 29(6):658-63. doi: 10.1007/s00482-015-0044-y
Banks K, Hengeveld H. Maitland’s vertebral manipulation, management of musculoskeletal disorders .Volumes 1. Amsterdam: Elsevier; 2013.
Konstantinou K, Foster N, Rushton A, Baxter D. The use and reported effects of mobilization with movement techniques in low back pain management; a cross-sectional descriptive survey of physiotherapists in Britain. Manual Therapy. 2002; 7(4):206-14. doi: 10.1054/math.2002.0469
Mulligan B. SNAGS: mobilisations of the spine with active movement. In: Boyling J, Jull G, editor. Grieve’s modern manual therapy, the vertebral column. London: Churchill Livingstone; 1994.
Reese NB, Bandy WD. Joint range of motion and muscle length testing. Amsterdam: Elsevier Health Sciences; 2010.
Williams R, Binkley J, Bloch R, Goldsmith CH, Minuk T. Reliability of the modified-modified Schöber and double inclinometer methods for measuring lumbar flexion and extension. Physical Therapy. 1993; 73(1):26-37. doi: /10.1093/ptj/73.1.26
Lenhard WLA. Calculation of effect sizes. Psychometrica. 2016. doi: 10.13140/RG.2.1.3478.4245.
Crawford JR, Garthwaite PH, Porter S. Point and interval estimates of effect sizes for the case-controls design in neuropsychology: Rationale, methods, implementations, and proposed reporting standards. Cognitive Neuropsychology. 2010; 27(3):245-60. doi: 10.1080/02643294.2010.513967
Elrazik RKA, Samir SM, Zaki LA, Koura GA. Mobilisation with movement versus postero-anterior mobilisation in chronic non specific low back pain. International Journal of PharmTech Research. 2016; 9(6):9-16.
Amro A, Diener I, Bdair WO, Isra’M H, Shalabi AI, Dua’I I. The effects of Mulligan mobilisation with movement and taping techniques on pain, grip strength, and function in patients with lateral epicondylitis. Hong Kong Physiotherapy Journal. 2010; 28(1):19-23. doi: 10.1016/j.hkpj.2010.11.004
Gilbreath JP, Gaven SL, Van Lunen BL, Hoch MC. The effects of mobilization with movement on dorsiflexion range of motion, dynamic balance, and self-reported function in individuals with chronic ankle instability. Manual Therapy. 2014; 19(2):152-7. doi: 10.1016/j.math.2013.10.001
Marrón-Gómez D, Rodríguez-Fernández ÁL, Martín-Urrialde JA. The effect of two mobilization techniques on dorsiflexion in people with chronic ankle instability. Physical Therapy in Sport. 2015; 16(1):10-5. doi: 10.1016/j.ptsp.2014.02.001
Teys P, Bisset L, Vicenzino B. The initial effects of a Mulligan’s mobilization with movement technique on range of movement and pressure pain threshold in pain-limited shoulders. Manual Therapy. 2008; 13(1):37-42. doi: 10.1016/j.math.2006.07.011
Moulson A, Watson T. A preliminary investigation into the relationship between cervical snags and sympathetic nervous system activity in the upper limbs of an asymptomatic population. Manual Therapy. 2006; 11(3):214-24. doi: 10.1016/j.math.2006.04.003
Reid SA, Rivett DA, Katekar MG, Callister R. Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Manual Therapy. 2008; 13(4):357-66. doi: 10.1016/j.math.2007.03.006
Hidalgo B, Pitance L, Hall T, Detrembleur C, Nielens H. Short-term effects of Mulligan mobilization with movement on pain, disability, and kinematic spinal movements in patients with nonspecific low back pain: A randomized placebo-controlled trial. Journal of Manipulative and Physiological Therapeutics. 2015; 38(6):365-74. doi: 10.1016/j.jmpt.2015.06.013
Konstantinou K, Foster N, Rushton A, Baxter D, Wright C, Breen A. Flexion mobilizations with movement techniques: the immediate effects on range of movement and pain in subjects with low back pain. Journal of Manipulative and Physiological Therapeutics. 2007; 30(3):178-85. doi: 10.1016/j.jmpt.2007.01.015
Powers CM, Beneck GJ, Kulig K, Landel RF, Fredericson M. Effects of a single session of posterior-to-anterior spinal mobilization and press-up exercise on pain response and lumbar spine extension in people with nonspecific low back pain. Physical Therapy. 2008; 88(4):485-93. doi: 10.2522/ptj.20070069
Shum GL, Tsung BY, Lee RY. The immediate effect of posteroanterior mobilization on reducing back pain and the stiffness of the lumbar spine. Archive Physical Medicine Rehabilitation. 2013; 94(4):673-9. doi: 10.1016/j.apmr.2012.11.020