Mackenzie Treatment versus Mulligan SNAGs for Chronic Mechanical Low back pain

Abstract

Background and Objective:Chronic mechanical low back pain is common among different age groups and genders. Different manual therapy techniques combined with exercise therapy and electrotherapy modalities play an important role in its management. Our objective was to compare the effects of McKenzie extension exercisesprogram (EEP) versus Mulligan Sustained Natural Apophyseal Glides (SNAGs) for chronic mechanical low back pain (CMLBP).Methods:This randomized control trial (RCT) was conducted at Riphah Physical Rehabilitation Centre, Pakistan Railways General Hospital Rawalpindi, from 1st July to 31st December 2014.The inclusion criteria was patients of both gender and age range 30-70 years with minimum 4 weeks history of CMLBP. A total of 37 patients were screened out as per inclusion criteria and randomly placed into two groups. Twenty patients in group A were treated with Mulligan SNAGs and 17 patients in group B with McKenzie EEP for four weeks at two session per week and single session per day. Visual Analogue Scale (VAS), Oswestry Disability Scale (ODI) and lumber Range of Motion (ROM) were used as an assessment tools and were measured at baseline and at the completion 4 weeks intervention. The data was analyzed with SPSS to draw the statistical and clinical significance of both interventions.Results:At the completion of 4 weeks intervention the pre and post statistical analysis revealed that clinically the McKenzie EEP improved pain (mean 9.12 to 1.46) and disability (73.82 to 6.24) slightly more than Mulligan SNAGs (pain: from 8.85 to 2.55, disability 73.75 to 7.05), while the Mulligan SNAGs improved lumbar ROM more effectively than McKenzie EEP in all directions including flexion, extension, side bending and rotation. Statistically there was no significant difference between the effects of two interventions in managing pain and disability, and improving Lumber ROM.Conclusion:McKenzie EEP is clinically slightly more effective in the management of pain and disability as compared with Mulligan SNAGs, while Mulligan SNAGs are more effective in the improvement of lumbar ROM as compared with Mechanize EEP in the management of CMLBP.

Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials

“…In total, 47 trials fulfilled the inclusion criteria, 21 of which were not included in the previous review (fig 1). 14 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72…”

“…The countries in which the studies were conducted varied. Fifteen studies were conducted in the United States,14 28 29 33 34 40 41 44 45 46 49 54 66 70 72 seven in the United Kingdom,32 35 38 39 50 69 73 three each in Finland,42 52 71 Australia,36 51 67 and Italy,31 55 65 two each in Sweden,57 61 Denmark,53 56 Egypt,58 60 and India,59 64 and one each in Belgium,43 Spain,30 Switzerland,27 the Netherlands,47 Greece,48 Turkey,63 Pakistan,68 and Tunisia 37. All trials were published in English except the trial conducted in Tunisia, which was published in French.…”

“…Affiliations —The primary investigators were affiliated with a department of physiotherapy or osteopathy within a university setting,14 27 30 33 36 49 57 58 59 63 64 65 72 health sciences department or similar within a university setting,29 41 43 46 47 48 51 52 53 54 61 62 67 71 department of medicine, rheumatology, or similar,35 37 38 50 55 56 60 68 chiropractic based research department,28 34 40 44 45 66 70 or clinician initiated (independent of a university or college)31 32 39 42 69…”

Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics

“…e glide occurs in the articular plane, and the movement is performed in loading [99]. e reports indicate that the addition of the SNAG technique to other rehabilitation methods improves the range of spinal mobility and reduces pain [100][101][102]. e literature also indicates that compared to incorrect mobilization, the SNAG technique did not bring better results in terms of mobility [99].…”

A narrative review of non-operative treatment, especially traditional Chinese medicine therapy, for lumbar intervertebral disc herniation

“…Mulligan Sustained Natural Apophyseal Glides (SNAGs) as one of most important manual therapy treatments is also widely used by physiotherapists to treat this condition. A randomized control trial was conducted by Waqqar et al to determine the effects of McKenzie extension exercise versus Mulligan SNAGs for chronic mechanical low back pain (78). They indicated that McKenzie extension exercises program is clinically slightly more effective in the management of pain and disability as compared with Mulligan SNAGs, while Mulligan SNAGs are more effective in the improvement of lumbar ROM as compared with Mechanize EEP in the management of CMLBP.…”