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

Effects of Mulligan Sustained Natural Apophyseal Glides Versus McKenzie Method of Mechanical Diagnosis & Therapy in Patients With Non-Specific Chronic Low Back Pain

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

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.

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.