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Comparison of Mulligan Bent Leg Raise and Sustained Natural Apophyseal Glides techniques in chronic low back pain

Year 2021, Volume: 8 Issue: 1, 82 - 89, 07.05.2021

Abstract

Purpose: The aim of this study was to compare the effectiveness of Mulligan Bent Leg Raise (BLR) and Sustained Natural Apophyseal Glides (SNAGS) techniques in chronic low back pain.
Methods: Forty-five individuals between the ages of 25-55 who had nonspecific low back pain at least 3 months were included in the study. The patients were randomly divided into 3 groups as Control group (n= 15), Mulligan BLR group (n= 15) and Mulligan SNAGS group (n= 15). In addition to the classical electrotherapy methods applied to all 3 groups; Mulligan BLR technique was applied to BLR group and Mulligan SNAGS technique was applied to SNAGS group. Patients’ pain at rest and in motion was evaluated with visual analog scale, lumbar range of motion with inclinometer, flexibility assessment with Schober and finger-floor test, and functional levels with Oswestry Low Back Pain Questionnaire before and after treatment.
Results: After treatment, a significant difference was determined in pain intensity during rest and movement and in the results of Schober test in all groups (p<0.001). The increase in range of motion of the patients in the SNAGS group was found to be significantly higher than the other groups (p<0.05). It was determined that the change in finger ground test in the SNAGS group was significantly higher than the other groups (p<0.05). When Oswestry results were compared, the change in the BLR group was significantly higher than the other groups (p <0.05).
Conclusion: Mulligan mobilization techniques were found effective in reducing pain, increasing range of motion, flexibility, and functionality. When the Mulligan mobilization groups were compared, it was determined that the BLR group was more effective in enhancing functionality than the SNAGS group, and the SNAGS group was more effective in enhancing joint range of motion and flexibility than the BLR group.

References

  • 1. Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int. 2019;39:619-626.
  • 2. Nabiyev V, Ayhan S, Acaroğlu E. Bel ağrısında tanı ve tedavi algoritması. TOTBİD Dergisi. 2015;14:242-251.
  • 3. Bento TPF, dos Santos Genebra CV, Maciel NM, et al. Low back pain and some associated factors: is there any difference between genders? Braz J Phys Ther. 2020;24:79-87.
  • 4. Tagliaferri SD, Miller CT, Owen, et al. Domains of chronic low back pain and assessing treatment effectiveness: A clinical perspective. Pain Pract. 2020;20:211-225.
  • 5. Urits I, Burshtein A, Sharma M, et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23:1-10.
  • 6. Javaherian M, Tajali SB, Moghaddam BA, et al. 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. J Mod Rehabil. 2017;11:127-132.
  • 7. Vicenzino B, Paungmali A, Teys P. Mulligan’s mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature. Man Ther. 2007;12:98–108.
  • 8. Kumar Singh B, Pattnaik M, et al. A Comparative Study of Mulligan Traction Straight Leg Raising and Dynamic Soft Tissue Mobilization to Increase Hamstrings Flexibility. J Nurs Health Sci. 2016;5:80-88.
  • 9. Exelby L. The Mulligan concept: its application in the management of spinal conditions. Man Ther. 2002;7:64-70.
  • 10. Moutzouri M, Billis E, Strimpakos N, et al. The effects of the Mulligan Sustained Natural Apophyseal Glide mobilisation in the lumbar flexion range of asymptomatic subjects as measured by the Zebris CMS20 3- D motion analysis system. BMC Musculoskelet Disord. 2008;9:1-9.
  • 11. Phansopkar PA, Kage V. Efficacy Of Mulligan’s Two Leg Rotation And Bent Leg Raise Techniques In Hamstring Flexibility In Subjects With Acute Non-Specific Low Back Pain: Randomized Clinical Trial. Int J Physiother Res; 2014;2:733-741.
  • 12. Hidalgo B, Pitance L, Hall T, et al. 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. J Manipulative Physiol Ther. 2019;38:365-374.
  • 13. Hussien HM, Abdel-Raoof NA, Kattabei OM, et al. Effect of Mulligan Concept Lumbar SNAG on Chronic Nonspecific Low Back Pain. J Chiropr Med. 2017;16:94-102.
  • 14. Mulligan B. Manual Therapy: Nags, Snags, MWMs, etc. 6th ed. Wellington: Plane View Services Ltd; 2010.
  • 15. Adams M.A, Dolon P, Marx C, et al. An electronic inclinometer technique for measuring lumbar spinal motion. Clin.Biomech, 1986;1:130-134.
  • 16. İnanoğlu D, Baltaci G. Nörolojik defisiti olmayan bel ağrılı hastalarda farklı bantlama tekniklerinin yaşam kalitesi ve ağrı üzerine etkisi. J Exerc Ther Rehabil. 2014;1:26-34.
  • 17. Tousignant M, Poulin L, Marchand S, et al. The Modified- Modified Schober Test for range of motion assessment of lumbar flexion in patients with low back pain: A study of criterion validity, intra-and inter-rater reliability and minimum metrically detectable change. Disabil Rehabil. 2005;27:553-559.
  • 18. Fritz JM, Whitman JM, Flynn TW, et al. Factors Related to the Inability of Individuals With Low Back Pain to Improve With a Spinal Manipulation. Phys Ther. 2004;84:173-790.
  • 19. Yakut E, Düger T, Oksüz C, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine. 2004;29:581-585.
  • 20. Hall T, Hardt S, Schäfer A, et al. Mulligan bent leg raise technique-a preliminary randomized trial of immediate effects after a single intervention. Man Ther. 2006;11:130-135.
  • 21. Tambekar N, Sabnis S, Phadke A, et al. Effect of Butler’s neural tissue mobilization and Mulligan’s bent leg raise on pain and straight leg raise in patients of low back ache. Journal of Bodywork and Movement Therapies. 2016;20, 280-285.
  • 22. Heggannavar A, Kale A. Immediate effect of modified lumbar SNAG in non-specific chronic patients: a pilot study. Physiother Res. 2015;3:1018-1023.
  • 23. Pawar AH, Metgud S. (2010). Comparative effectiveness of Mulligan’s traction straight leg raise and bent leg raise in low back ache with radiculopathy—a randomized clinical trial (Doctoral dissertation, KLE University, Belgaum, Karnataka).
  • 24. Waqqar S, Shakil-ur-Rehman S, Ahmad S. McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain. Pak J Med Sci. 2016;32:476-479.

Kronik bel ağrısında Mulligan Bent Leg Raise ve Sustained Natural Apophyseal Glides tekniklerinin karşılaştırılması

Year 2021, Volume: 8 Issue: 1, 82 - 89, 07.05.2021

Abstract

Amaç: Çalışmada Mulligan Bent Leg Raise (BLR) ve Sustained Natural Apophyseal Glides (SNAGS) tekniklerinin kronik bel ağrısındaki etkinliğinin karşılaştırılması amaçlandı.
Yöntem: Çalışmaya yaşları 25-55 arasında, spesifik olmayan bel ağrısı şikâyeti en az 3 aydır devam eden 45 birey alındı. Hastalar randomize bir şekilde, Kontrol grubu (n=15), Mulligan BLR grubu (n=15) ve Mulligan SNAGS grubu (n=15) olarak 3’e ayrıldı. Her 3 gruba uygulanan klasik elektroterapi yöntemlerine ilave olarak BLR grubuna Mulligan BLR tekniği, SNAGS grubuna Mulligan SNAGS tekniği uygulandı. Hastaların dinlenme ve hareket durumundaki ağrısı görsel analog skala ile, lumbar bölge eklem hareket açıklığı inklinometre ile, esneklik değerlendirmesi Schober ve parmak-zemin testi ile ve fonksiyonel düzeyleri Oswestry Bel Ağrısı Anketi ile tedavi öncesi ve sonrasında değerlendirildi.
Bulgular: Tedavi sonrasında tüm gruplarda istirahat ve hareket esnasında ağrı şiddetlerinde ve Schober testi sonuçlarında anlamlı fark belirlendi (p<0,05). SNAGS grubundaki olguların eklem hareket açıklıklarındaki artış diğer gruplara göre anlamlı olarak daha yüksek bulundu (p<0,05). SNAGS grubundaki parmak zemin testindeki değişimin diğer gruplara göre anlamlı olarak daha yüksek olduğu belirlendi (p<0,05). Oswestry skalası sonuçları karşılaştırıldığında, BLR grubundaki değişim diğer gruplara kıyasla anlamlı olarak daha yüksekti (p<0,05).
Sonuç: Mulligan mobilizasyon teknikleri ağrı azalmasında, eklem hareket açıklığı, esneklik ve fonksiyonelliğin artmasında etkili bulundu. Mulligan mobilizasyon grupları karşılaştırıldığında BLR grubunun fonksiyonelliği arttırmada SNAGS grubuna göre daha etkili olduğu, SNAGS grubunun eklem hareket açıklığı ve esnekliği arttırmada BLR grubuna göre daha etkili olduğu belirlendi.

References

  • 1. Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int. 2019;39:619-626.
  • 2. Nabiyev V, Ayhan S, Acaroğlu E. Bel ağrısında tanı ve tedavi algoritması. TOTBİD Dergisi. 2015;14:242-251.
  • 3. Bento TPF, dos Santos Genebra CV, Maciel NM, et al. Low back pain and some associated factors: is there any difference between genders? Braz J Phys Ther. 2020;24:79-87.
  • 4. Tagliaferri SD, Miller CT, Owen, et al. Domains of chronic low back pain and assessing treatment effectiveness: A clinical perspective. Pain Pract. 2020;20:211-225.
  • 5. Urits I, Burshtein A, Sharma M, et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23:1-10.
  • 6. Javaherian M, Tajali SB, Moghaddam BA, et al. 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. J Mod Rehabil. 2017;11:127-132.
  • 7. Vicenzino B, Paungmali A, Teys P. Mulligan’s mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature. Man Ther. 2007;12:98–108.
  • 8. Kumar Singh B, Pattnaik M, et al. A Comparative Study of Mulligan Traction Straight Leg Raising and Dynamic Soft Tissue Mobilization to Increase Hamstrings Flexibility. J Nurs Health Sci. 2016;5:80-88.
  • 9. Exelby L. The Mulligan concept: its application in the management of spinal conditions. Man Ther. 2002;7:64-70.
  • 10. Moutzouri M, Billis E, Strimpakos N, et al. The effects of the Mulligan Sustained Natural Apophyseal Glide mobilisation in the lumbar flexion range of asymptomatic subjects as measured by the Zebris CMS20 3- D motion analysis system. BMC Musculoskelet Disord. 2008;9:1-9.
  • 11. Phansopkar PA, Kage V. Efficacy Of Mulligan’s Two Leg Rotation And Bent Leg Raise Techniques In Hamstring Flexibility In Subjects With Acute Non-Specific Low Back Pain: Randomized Clinical Trial. Int J Physiother Res; 2014;2:733-741.
  • 12. Hidalgo B, Pitance L, Hall T, et al. 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. J Manipulative Physiol Ther. 2019;38:365-374.
  • 13. Hussien HM, Abdel-Raoof NA, Kattabei OM, et al. Effect of Mulligan Concept Lumbar SNAG on Chronic Nonspecific Low Back Pain. J Chiropr Med. 2017;16:94-102.
  • 14. Mulligan B. Manual Therapy: Nags, Snags, MWMs, etc. 6th ed. Wellington: Plane View Services Ltd; 2010.
  • 15. Adams M.A, Dolon P, Marx C, et al. An electronic inclinometer technique for measuring lumbar spinal motion. Clin.Biomech, 1986;1:130-134.
  • 16. İnanoğlu D, Baltaci G. Nörolojik defisiti olmayan bel ağrılı hastalarda farklı bantlama tekniklerinin yaşam kalitesi ve ağrı üzerine etkisi. J Exerc Ther Rehabil. 2014;1:26-34.
  • 17. Tousignant M, Poulin L, Marchand S, et al. The Modified- Modified Schober Test for range of motion assessment of lumbar flexion in patients with low back pain: A study of criterion validity, intra-and inter-rater reliability and minimum metrically detectable change. Disabil Rehabil. 2005;27:553-559.
  • 18. Fritz JM, Whitman JM, Flynn TW, et al. Factors Related to the Inability of Individuals With Low Back Pain to Improve With a Spinal Manipulation. Phys Ther. 2004;84:173-790.
  • 19. Yakut E, Düger T, Oksüz C, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine. 2004;29:581-585.
  • 20. Hall T, Hardt S, Schäfer A, et al. Mulligan bent leg raise technique-a preliminary randomized trial of immediate effects after a single intervention. Man Ther. 2006;11:130-135.
  • 21. Tambekar N, Sabnis S, Phadke A, et al. Effect of Butler’s neural tissue mobilization and Mulligan’s bent leg raise on pain and straight leg raise in patients of low back ache. Journal of Bodywork and Movement Therapies. 2016;20, 280-285.
  • 22. Heggannavar A, Kale A. Immediate effect of modified lumbar SNAG in non-specific chronic patients: a pilot study. Physiother Res. 2015;3:1018-1023.
  • 23. Pawar AH, Metgud S. (2010). Comparative effectiveness of Mulligan’s traction straight leg raise and bent leg raise in low back ache with radiculopathy—a randomized clinical trial (Doctoral dissertation, KLE University, Belgaum, Karnataka).
  • 24. Waqqar S, Shakil-ur-Rehman S, Ahmad S. McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain. Pak J Med Sci. 2016;32:476-479.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Bilge Büşra Komsuoğlu 0000-0003-4896-9163

Gülay Aras Bayram 0000-0002-5592-7546

Candan Algun 0000-0002-2476-6567

Publication Date May 7, 2021
Submission Date February 14, 2020
Published in Issue Year 2021 Volume: 8 Issue: 1

Cite

Vancouver Komsuoğlu BB, Aras Bayram G, Algun C. Kronik bel ağrısında Mulligan Bent Leg Raise ve Sustained Natural Apophyseal Glides tekniklerinin karşılaştırılması. JETR. 2021;8(1):82-9.