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

Vignesh Bhat P, Vivek Dineshbhai Patel, Charu Eapen, Manisha Shenoy, Steve Milanese, Vignesh Bhat P, Vivek Dineshbhai Patel, Charu Eapen, Manisha Shenoy, Steve Milanese

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/).

Keywords: Mulligan SNAGs; Myofascial release; Non-specific low back pain; Strengthening exercises.

Conflict of interest statement

Manisha P. Shenoy is employed as a physiotherapy specialist at Hamad Medical Corporation, Doha, Qatar.

©2021 Bhat P et al.

Figures

Figure 1. CONSORT flow diagram.
Figure 1. CONSORT flow diagram.
Figure 2. Mulligan SNAGs technique.
Figure 2. Mulligan SNAGs technique.
(A)- Starting Neutral Position (B) - Neutral to Extension SNAGs.
Figure 3. Myofascial release technique.
Figure 3. Myofascial release technique.

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