Central Postero Anterior Glide with Static Hamstring Stretch Versus Sustained Natural Apophyseal Glides with Two Leg Rotation in Nonspecific Low Back Pain:- A Randomized Controlled Trial Study

Abstract

Introduction:

 Non-specific low back pain (NSLBP) is a typical difficulty in the field of musculoskeletal healthcare, leading to the development of several disabilities.

A significant contributing element to the reversible mechanical alterations in lumbopelvic rhythm among the several components is tension in the hamstring muscles.

 The present study aims to determine the best treatment approach for treating NSLBP to reduce disability and improve flexibility and range of motion by comparing the effectiveness of two manual therapy techniques: Central PA Glide with static Hamstring Stretch and SNAG with two leg rotation.

Methodology:

A Randomized Controlled Trial has been conducted at Central Referral Hospital at Physiotherapy OPD in Gangtok.

All patients with low back pain were referred from other departments and has been screened for non-specific low back pain according to eligibility criteria.

Random assigned to one of two groups has been enrolled through consecutive sampling techniques and randomization done by concealed envelope method. The study had a total sample size of 68 patients, of which 33 were assigned to Group A and 35 to Group B.

In total four weeks of the intervention period

Group-A received Central Postero Anterior Glide with Static Hamstring Stretch, and Lumbar Stabilization Exercise three times a week.

 Group-B received Mulligan Sustained Natural Apophyseal Glides with Two Leg Rotation three times a week along with Lumbar Stabilization Exercise.

Results are measured using the Active Knee Extension for Hamstring muscle Flexibility, the Schober Test (Modified) for Lumbar Range of Motion, and the Oswestry Disability Index for Disability assessment.

 Post-intervention evaluation is conducted from the first to fourth weeks of treatment.

ODI (for Disability)  is followed up by telecommunication after two months.

Result:

Mulligan SNAG with Two Leg Rotation and Lumbar Stabilization exercise and Maitland Central PA glide with static hamstring stretch with Lumbar stabilization exercise have shown significant improvements in their respective groups.

In between group analysis Mulligan SNAG with Two Leg Rotation with Lumbar Stabilization exercises revealed a statistically significant change in Disability (P<0.001), Flexibility (P<0.001), and ROM for Flexion (P<0.001) and Extension(P<0.001) in comparison to Maitland Central PA glide with static hamstring stretch with lumbar stabilization exercises group.

Follow-up for ODI after 2 months showed statically significant differences between the group analyses.

Conclusion: There is a significant difference in the improvement of outcomes related to NSLBP when Mulligan SNAGs and two-leg rotation with lumbar stabilization exercises has been applied as a treatment approach.