title: McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain.
abstract: OBJECTIVE
  Chronic mechanical low back pain is common among different age groups and genders. Different manual therapy techniques combined with exercise therapy and electrotherapy modalities play an important role in its management. Our objective was to compare the effects of McKenzie extension exercisesprogram (EEP) versus Mulligan Sustained Natural Apophyseal Glides (SNAGs) for chronic mechanical low back pain (CMLBP).
  
  
  METHODS
  This randomized control trial (RCT) was conducted at Riphah Physical Rehabilitation Centre, Pakistan Railways General Hospital Rawalpindi, from 1(st) July to 31(st) December 2014. The inclusion criteria was patients of both gender and age range 30-70 years with minimum 4 weeks history of CMLBP. A total of 37 patients were screened out as per inclusion criteria and randomly placed into two groups. Twenty patients in group A were treated with Mulligan SNAGs and 17 patients in group B with McKenzie EEP for four weeks at two session per week and single session per day. Visual Analogue Scale (VAS), Oswestry Disability Scale (ODI) and lumber Range of Motion (ROM) were used as an assessment tools and were measured at baseline and at the completion 4 weeks intervention. The data was analyzed with SPSS to draw the statistical and clinical significance of both interventions.
  
  
  RESULTS
  At the completion of 4 weeks intervention the pre and post statistical analysis revealed that clinically the McKenzie EEP improved pain (mean 9.12 to 1.46) and disability (73.82 to 6.24) slightly more than Mulligan SNAGs (pain: from 8.85 to 2.55, disability 73.75 to 7.05), while the Mulligan SNAGs improved lumbar ROM more effectively than McKenzie EEP in all directions including flexion, extension, side bending and rotation. Statistically there was no significant difference between the effects of two interventions in managing pain and disability, and improving Lumber ROM.
  
  
  CONCLUSIONS
  McKenzie EEP is clinically slightly more effective in the management of pain and disability as compared with Mulligan SNAGs, while Mulligan SNAGs are more effective in the improvement of lumbar ROM as compared with Mechanize EEP in the management of CMLBP.
authors.affiliation: Dr. Saira Waqqar, DPT (Post Professional), Lecturer, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan.
authors.forename: Saira
authors.initials: S
authors.lastname: Waqqar
authors.affiliation: Dr. Syed Shakil-ur-Rehman, MS (MSKPT), Principal/ Associate Professor, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan.
authors.forename: Syed
authors.initials: S
authors.lastname: Shakil-Ur-Rehman
authors.affiliation: Dr. Shakeel Ahmad, MS (NMSKPT), Assistant Professor, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan.
authors.forename: Shakeel
authors.initials: S
authors.lastname: Ahmad
keywords: Chronic Mechanical Low Back Pain; McKenzie Extension Exercise Program; MulliganSustained Natural Apophyseal Glides