Mulligan Mobilization Techniques for Non-Specific Low Back Pain

Official title

Comparison of the Effectiveness of Two Different Mulligan Mobilization Techniques in Patients With Non-Specific Low Back Pain: A Triple-Blind Randomized Controlled Trial

Overview

This study aims to compare the effectiveness of two different Mulligan mobilization techniques in patients with non-specific low back pain. A total of 30 adults with chronic low back pain will be randomly assigned to three groups: (1) conventional physiotherapy plus hip internal rotation Mulligan mobilization, (2) conventional physiotherapy plus straight leg raise Mulligan mobilization, or (3) conventional physiotherapy only. The interventions will be applied twice a week for four weeks. The main outcomes are pain intensity (measured by Visual Analog Scale) and lumbar range of motion. Secondary outcomes include disability level (Oswestry Disability Index) and back awareness (Fremantle Back Awareness Questionnaire). The study will help determine whether Mulligan techniques provide additional benefits beyond conventional physiotherapy in reducing pain and improving function in people with non-specific low back pain.

Detailed description

Low back pain is the second most common cause of disability worldwide and significantly affects quality of life and healthcare systems. Non-specific low back pain (NSLBP) accounts for nearly 85% of all low back pain cases and is associated with loss of function, reduced productivity, and psychological problems. Physiotherapy approaches such as exercise, manual therapy, electrotherapy, and patient education are widely used, but not all patients benefit equally, highlighting the need for innovative and individualized treatment strategies. Mulligan mobilization is a manual therapy method that combines physiological joint movements with pain-free mobilization techniques. Techniques such as hip mobilization and traction-assisted straight leg raise (SLR) are thought to improve pain, range of motion, and functional outcomes. Although some studies suggest positive effects of Mulligan techniques, there is a lack of randomized controlled trials directly comparing different Mulligan approaches in patients with NSLBP. This triple-blind randomized controlled trial will investigate the comparative effectiveness of two Mulligan mobilization techniques. Thirty adults with NSLBP will be randomly assigned into three groups: (1) conventional physiotherapy plus hip internal rotation Mulligan mobilization, (2) conventional physiotherapy plus SLR Mulligan mobilization, and (3) conventional physiotherapy only. Interventions will be delivered twice a week for four weeks by experienced physiotherapists certified in the Mulligan Concept®. The primary outcomes will be pain intensity measured with the Visual Analog Scale (VAS) and lumbar range of motion assessed by goniometer. Secondary outcomes include disability level measured with the Oswestry Disability Index (ODI) and back awareness assessed with the Fremantle Back Awareness Questionnaire (FreBAQ). The findings of this study are expected to provide evidence on whether Mulligan mobilization techniques offer additional benefits beyond conventional physiotherapy in the management of non-specific low back pain.

Interventions

• Behavioral Hip Internal Rotation Mulligan Mobilization
  Mulligan mobilization applied to hip internal rotation using a mobilization belt. Performed in 3 sets of 10 repetitions, twice weekly for 4 weeks, in addition to conventional physiotherapy.
• Behavioral Straight Leg Raise Mulligan Mobilization
  Mulligan mobilization applied to straight leg raise under manual traction. Performed in 3 sets of 10 repetitions (15-20 seconds hold), twice weekly for 4 weeks, in addition to conventional physiotherapy.
• Behavioral Conventional Physiotherapy
  Conventional physiotherapy including transcutaneous electrical nerve stimulation (20 minutes), massage, lumbar stretching and strengthening exercises, postural training, and patient education. Delivered twice weekly for 4 weeks.

Primary outcome measures

• Pain Intensity (Visual Analog Scale, VAS) [Time frame: Baseline (week 0) and post-treatment (week 4).]
• Lumbar Range of Motion (ROM) [Time frame: Baseline (week 0) and post-treatment (week 4).]

Secondary outcome measures (2)

• Disability Level (Oswestry Disability Index - ODI) [Time frame: Baseline (week 0) and post-treatment (week 4)]
• Back Awareness (Fremantle Back Awareness Questionnaire - FreBAQ) [Time frame: Baseline (week 0) and post-treatment (week 4).]

Eligibility criteria

Inclusion criteria

• Age ≥ 18 years
• Diagnosed with non-specific low back pain (NSLBP) for at least 3 months
• Able to walk independently
• Willing to participate and provide written informed consent

Exclusion criteria

• Specific causes of low back pain (e.g., disc herniation, spinal stenosis, tumor)
• Presence of neurological deficits or radiculopathy
• Hip joint pathologies limiting mobility (e.g., osteoarthritis)
• History of lumbar surgery in the last 6 months
• Diagnosed osteoporosis or osteopenia
• Contraindications for Mulligan mobilization
• Severe physical or cognitive impairments preventing participation
• Participation in other physiotherapy or manual therapy treatments during the study period

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Triple blind

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitatio — Ankara

Identifiers

NCT: NCT07181395 · GU-ETHICS-2025-08-863 · GU-Ethics-08/863

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗