Comparison of immediate effects following postro-anterior mobilization technique and Mulligan sustained natural apophyseal glide on chronic nonspecific low back pain

Comparison of immediate effect of sustained natural apophyseal glide and posterior-anterior techniques in non-specific chronic low back pain

A concealed, randomized, double-blinded,multi-center, sham controlled clinical trial with a parallel group design of 45 patients

Three physiotherapy centers selected for sampling and 45 patients included to study after receiving informed consent. Each patient were entered to one of three groups (SNAG, PA Mobilization & sham) by block balanced randomization and received intervention by an expert manual therapist. All patients were assessed before and immediately after the intervention by another researcher who was blinded to patients allocation. Also all patients were blinded to groups because sham intervention was similar to SNAG technique.

Patients were included with localized chronic non-specific low back pain, age between 20 to 50 years, that their pain were worsened during flexion and L4 as most painful lumbar segment. Patients with any type of sensory or motor disorders, malignancy, osteoporosis or any type of contraindication of mobilization excluded.

Sustained natural apophyseal glide (SNAG) on L4 during 4 sets of 6 repetitions with 30 seconds rest between sets with cranial direction. Posterior-anterior mobilization on L4 with grade 3 during 4 sets of 30 seconds duration with 30 seconds rest between them. Sham intervention likes SNAG technique, but only skin touch without mobilization and caudal direction during 2 sets of 4 repetitions.

Pin Pressure threshold (PPT) at 3 cm right to L3 spinous process, L3 dermatome, L4 dermatome and S1 dermatome; Flexion, Extention, Right and Left Lateral bendings and rotations range of motions; Pain at rest and during forward flexion.

budget thesis of Rehabilitation of Tehran University of medical sciences.

Block balanced randomization

Block balances randomization set before trial starting and was wrote in closed envelopes and sort them by number. Every participant that entered in study, therapist opened one envelope to find participant's grouping, but assessor was not aware about patient's group, because assessment was done in another room. Our sham treatment was very similar to Mulligan technique. therefore, No patient found that this was not real treatment, therefore patients and assessor were not aware about groups and only therapist was aware.