Myofascial release versus Mulligan sustained natural apophyseal glides’ immediate and short-term effects on pain, function, and mobility in non-specific low back pain

Abstract

Background Myofascial release (MFR) and Mulligan Sustained Natural Apophyseal Glides (SNAGs) are manual therapy techniques routinely practiced in the management of non-specific low back pain (NSLBP). As a solo intervention or along with other therapies, both methods have reported positive results for individuals with NSLBP. However, which technique improves NSLBP-related pain, restricted range of motion (ROM) and disability, warrants further research. Objective To study the comparative effects of MFR and SNAGs on pain, disability, functional ability, and lumbar ROM in NSLBP. Method A parallel-group study was conducted at tertiary care hospitals. Sixty-five Sub-acute or chronic NSLBP patients were allocated to receive strengthening exercises along with either MFR (n = 33) or SNAGs (n = 32) for six treatment sessions over one week. An independent assessor evaluated outcome measures such as the Visual Analog Scale (VAS), Patient-Specific Function Scale (PSFS), and ROM at baseline, immediate (after 1st treatment), and short-term (post-sixth day of the intervention). The Modified Oswestry disability index (MODI) was assessed at baseline and short-term. Results Within-group analysis found clinically and statistically significant (p < 0.05) changes for VAS and PSFS at immediate and short-term for both the groups. The lumbar extension also showed improvement immediately and in the short-term. Improvement in Lumbar flexion was seen only in the SNAGs group over the short-term. A statistically significant improvement was seen for MODI in both the groups but was not clinically significant in the MFR group. The analysis observed no statistically significant difference (p < 0.05) between the groups at both the immediate and short-term. Conclusions Pain and restricted function associated with NSLBP can be improved using SNAGs or MFR, along with strengthening exercises. For limited lumbar flexion ROM, Mulligan SNAGs have a better outcome than MFR over the short-term. Hence, both manual therapy techniques can be incorporated along with exercises for immediate and short-term management of sub-acute to chronic NSLBP. Clinical Trial Registration. CTRI/2018/12/016787 (http://ctri.nic.in/Clinicaltrials/).

Effects of Lumbar Snag and Mechanical Traction in Patients With Discogenic Lumbosacral Radiculopathy

“…The results of this study are in accordance with the study done by Bhat et al They saw the effects of spinal mobilization in lumber radiculopathy and results were in accordance with our study. There was significant improvement in pain with p-value <0.05 14 .…”

Myofascial Release on Pain and Function in Adults with Low Back Pain: A systematic review

“…Another study by Bhat et al (2021) showed a consistent result that using MFR therapy on lumbar to sacroiliac muscles with strengthening exercise enabled them to reduce pain and physical disability among patients with LBP. Boff et al (2021) reported the combination of spinal manipulation and MFR has yielded a similar effect in pain intensity and disability compared to the spine manipulation group post-3-week intervention and at follow-up.…”

“…Some studies use MFR alone compared to sham MFR (Arguisuelas et al, 2017), or the electrotherapy modalities (Tamartash & Bahrpeyma, 2022). Previous studies evaluated the effects of MFR on the back and lower limb muscles (Arguiselas et al, 2017;Balasubramaniam et al, 2014;Branchini et al, 2015); combined MFR with manual therapy (Ajimsha et al, 2014) or physical modality (Arun 2014) or active exercises (Ajimsha et al, 2014;Bhat et al, 2021;Yu et al, 2016).…”

“…MFR is a manual therapy that stimulates mechanoreceptors in the lumbar spine's soft tissues and facet joints and aids in correcting abnormalities within the movement system, which may enhance the activation pattern of para-spinal muscles, resulting in increased pain-free ROM (Bhat et al, 2021). The action of these receptors continuously feeds the central nervous system, allowing neuro-reflexive muscle activation, reducing pain, and physical impairment, and subsequently improving lumbar spine ROM (Bhat et al, 2021). MFR also aids vascular and lymphatic circulation (Harrison et al, 2000).…”

A Review on Treatment Approaches for Chronic Low Back Pain via Mulligans Movement With Mobilization and Physical Therapy

“…Manual therapy is a specialized area in physiotherapy which manages neuromuscular pain. Manual therapy techniques include the Maitland mobilization technique, Kaltenborn mobilization technique, Mulligan technique [6], active release technique, and many more. Manual therapy mainly works on arthrokinematics and osteokinematics of the joint.…”