Mulligan Sustained Natural Apophyseal Glides Versus McKenzie Method in Patients With Non-Specific Chronic Low Back Pain

NCT ID: NCT05840666

Last Updated: 2023-06-22

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 170 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-01-01
• Study Completion Date: 2023-06-15

Brief Summary

Low back pain (LBP) is the most frequent complaint encountered in clinical practice. Exercises and manual therapy prescription are common physical therapy treatments prescribed for the patients presenting with chronic low back pain. The interventions will establish the future direction for practitioners in choosing the manual therapy or repeated exercises as effective prescription and provide a basis for future research

Detailed Description

A variety of treatment interventions, modalities and techniques are used in physical therapy management of non-specific low back pain including manual therapy, exercises, neural mobilizations, stretching soft tissue techniques and dry needling etc. Out of these more recent literature supports manual therapy, self exercises, patient counseling and awareness have been recommended in back pain management guidelines, in the United States and is also frequently used in clinical practice in various countries.

Despite multiple theoretical frame works proposing the role of SNAGs and MDT mobilizations and exercises respectively, the literature on the true mechanism of direct or indirect physiological effects of these on performance or performance-related outcomes is vague and lacks justifiable procedural rigor.

The results of this study will provide information regarding the direction for practitioners in choosing the manual therapy or repeated exercises as effective prescription and provide a basis for future research.

Conditions

Low Back Pain

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Conventional Physical Therapy (CPT) Group

Conventional Physical Therapy will consist of Therapeutic Ultrasound, Moist Heat-pack, TENS and standard exercises. Participants will receive 15 sessions of Conventional Physical Therapy (CPT) at a frequency of 5 sessions per week.

Group Type: ACTIVE_COMPARATOR

Conventional Physical Therapy

Intervention Type: OTHER

It includes usual physical therapy care such as Therapeutic Ultrasound, Moist Heat-pack, TENS and standard exercises.

Conventional Physical Therapy (CPT) plus Mulligan SNAGs Group

Besides Conventional Physical Therapy, Mulligan Mobilizations will be provided in this group. It consist of Extension SNAGS in prone, and Lumbar flexion SNAGS in sitting. The techniques will be applied in 3 sets with 10 repetitions and 60 seconds rest between sets.

Group Type: EXPERIMENTAL

Mulligan Sustained Natural Apophyseal Glide (SNAG)

Intervention Type: OTHER

Application of the MWM technique developed by Brian R. Mulligan. The clinical researcher will perform and holds sustained passive segmental glide at the target joint maintaining the slack whereas the patient will actively move in the direction of pain or stiffness. These MWM techniques when applied to spinal segments or joint is called sustained natural apophyseal glide (SNAG).

Conventional Physical Therapy plus McKenzie MDT Group

Along with Conventional Physical Therapy, McKenzie MDT will be be given in this group. It consist of Prone lying, Prone lying Elbow popups, Prone elbow Extension. Standing Extension, supine Both Knee to Chest, Sitting on chair with forward flexion. The techniques will be applied in 3 sets with 8-10 repetitions and 60 seconds rest between sets.

Group Type: EXPERIMENTAL

McKenzie Method

Intervention Type: OTHER

An active therapy technique involving repeated movements or sustained positions along with an educational component prescribed to the patient for of minimizing the pain and disability and increase the spinal range of motion. The method will involve the assessment of symptomatic and mechanical responses to repeated movements and sustained positions in the direction of preference. The method will be used for assessment and treatment of patients and with derangement syndrome.

Interventions

Mulligan Sustained Natural Apophyseal Glide (SNAG)

Application of the MWM technique developed by Brian R. Mulligan. The clinical researcher will perform and holds sustained passive segmental glide at the target joint maintaining the slack whereas the patient will actively move in the direction of pain or stiffness. These MWM techniques when applied to spinal segments or joint is called sustained natural apophyseal glide (SNAG).

Intervention Type: OTHER

McKenzie Method

An active therapy technique involving repeated movements or sustained positions along with an educational component prescribed to the patient for of minimizing the pain and disability and increase the spinal range of motion. The method will involve the assessment of symptomatic and mechanical responses to repeated movements and sustained positions in the direction of preference. The method will be used for assessment and treatment of patients and with derangement syndrome.

Intervention Type: OTHER

Conventional Physical Therapy

It includes usual physical therapy care such as Therapeutic Ultrasound, Moist Heat-pack, TENS and standard exercises.

Intervention Type: OTHER

Other Intervention Names

Mulligan Mobilization; Mechanical Diagnosis and Therapy (MDT)

Eligibility Criteria

Inclusion Criteria

• Patients of Both genders
• Adult patents between the 20 to 45 years of age with chronic non-specific low back pain.
• Pain intensity of at least 3 or greater on 0-10 Numeric Rating Scale.
• Modified Low Back Pain Disability Questionnaire score equal to or greater than 20%.

Exclusion Criteria

• Serious underlying pathology with red flags.
• Patients having contraindication to physical exercises.
• Females with high parity.
• Pregnant or lactating females.
• Patients who participated in any type of rehabilitative training or exercise program for back pain in last 1 month.
• Spinal deformity or Spinal stenosis.
• History of fall or trauma to spine in last one year.
• History of spinal, abdominal or hip surgery.
• Signs of nerve root compression with sensory, motor or deep tendon reflexes deficit.
• Serious underlying pathology with red flags.
• Systemic disease e.g., cardiovascular, metabolic or central nervous system.
• Osteopenia, osteoporosis.
• Medication's history (steroids, immunosuppressants, chemotherapy)
• Limb length discrepancy.

• Minimum Eligible Age: 20 Years
• Maximum Eligible Age: 45 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Ayesha Jamil

OTHER

Sponsor Role: lead

Responsible Party

Ayesha Jamil

Assistant Professor

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Prof. Dr Ashfaq Ahmed, PhD

Role: STUDY_CHAIR

University of Lahore

Locations

The University of Lahore

Lahore, Punjab Province, Pakistan

Countries

Pakistan

Other Identifiers

Ahsan Javed

Identifier Type: -

Identifier Source: org_study_id