title: Short-term effects of Mulligan mobilization with movement on pain, disability, and kinematic spinal movements in patients with nonspecific low back pain: a randomized placebo-controlled trial.
abstract: OBJECTIVE
  The purpose of this clinical study was to compare the immediate- and short-term effects of lumbar Mulligan sustained natural apophyseal glides (SNAGs) on patients with nonspecific low back pain with respect to 2 new kinematic algorithms (KA) for range of motion and speed as well as pain, functional disability, and kinesiophobia.
  
  
  METHODS
  This was a 2-armed randomized placebo-controlled trial. Subjects, blinded to allocation, were randomized to either a real-SNAG group (n = 16) or a sham-SNAG group (n = 16). All patients were treated during a single session of real/sham SNAG (3 × 6 repetitions) to the lumbar spine from a sitting position in a flexion direction. Two new KA from a validated kinematic spine model were used and recorded with an optoelectronic device. Pain at rest and during flexion as well as functional disability and kinesiophobia was recorded by self-reported measures. These outcomes were blindly evaluated before, after treatment, and at 2-week follow-up in both groups.
  
  
  RESULTS
  Of 6 variables, 4 demonstrated significant improvement with moderate-to-large effect sizes (ES) in favor of the real-SNAG group: KA-R (P = .014, between-groups ES Cliff δ = -.52), pain at rest and during flexion (visual analog scale, P < .001; ES = -.73/-.75), and functional-disability (Oswestry Disability Index, P = .003 and ES = -.61). Kinesiophobia was not considered to be significant (Tampa scale, P = .03) but presented moderate ES = -.46. Kinematic algorithms for speed was not significantly different between groups (P = .118) with a small ES = -.33. All 6 outcome measures were significantly different (P ≤ .008) during within-group analysis (before and after treatment) only in the real-SNAG group. No serious or moderate adverse events were reported.
  
  
  CONCLUSIONS
  This study showed evidence that lumbar spine SNAGs had a short-term favorable effect on KA-R, pain, and function in patients with nonspecific low back pain.
authors.affiliation: Professor, Institute of Experimental and Clinical Research, Faculty of Motor Sciences, University of Louvain, Parnasse-ISEI, Brussels, Belgium; Head of Orthopedic Manual Therapy, Continuing Education Program, Institute of Experimental and Clinical Research, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium. Electronic address: benjamin.hidalgo@uclouvain.be.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hidalgo
authors.affiliation: Head of Orthopedic Manual Therapy, Continuing Education Program, Institute of Experimental and Clinical Research, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium; Professor, Institute of Experimental and Clinical Research, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium.
authors.forename: Laurent
authors.initials: L
authors.lastname: Pitance
authors.affiliation: Adjunct Senior Teaching Fellow, School of Physiotherapy, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.
authors.forename: Toby
authors.initials: T
authors.lastname: Hall
authors.affiliation: Professor, Institute of Experimental and Clinical Research, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium.
authors.forename: Christine
authors.initials: C
authors.lastname: Detrembleur
authors.affiliation: Professor, Institute of Experimental and Clinical Research, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium.
authors.forename: Henri
authors.initials: H
authors.lastname: Nielens
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D009068:Movement; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011379:Prognosis; D016059:Range of Motion, Articular / Q000502:physiology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Low Back Pain; Musculoskeletal Manipulations; Randomized Controlled Trial