Comparison of two mobilization techniques in management of chronic non-specific low back pain.

AIM: The aim of the study was to compare between the effects of Maitland's postero-anterior (PA glide) mobilization and Mulligan's sustained natural apophyseal glide (SNAG) on pain, mobility, muscle activation and functional disability in subjects with chronic, non-specific low back pain. METHODS: The study was a two arm repeated measure design with random allocation of subjects (n = 33). Subjects in group 1 received Maitland's PA glide mobilization and those in group 2 received Mulligan's SNAG. Along with the respective mobilization technique, individualized exercises were common for subjects in both the groups. Subjects in both groups received treatment for 4 days a week for 4 weeks. The outcome measures were numeric pain rating scale (NPRS) scores, lumbar flexion and extension range of motion, erector spinae muscle activity and Oswestry low back pain disability questionnaire score. RESULTS: The outcome measure scores showed statistical significance in time effect on NPRS (p = 0.001); lumbar flexion and extension range of motion (p = 0.001); erector spinae muscle activity (0.001); Oswestry low back pain disability questionnaire score (p = 0.001); group effect on lumbar flexion (p = 0.03) and extension range of motion (p = 0.05); and interaction effect (time x group) on lumbar flexion (p = 0.003) and extension range of motion (p = 0.002); and, erector spinae muscle activity (p = 0.05) at the 3rd lumbar vertebral level. CONCLUSION: The addition of Maitland or Mulligan mobilization techniques of the spine does not show a difference in the improvement of symptoms associated with chronic non-specific low back pain.

Scapular muscles strengthening on pain, functional outcome and muscle activity in chronic lateral epicondylalgia.

AIM: The aim of the study was to investigate the effect of lower trapezius (LT), middle trapezius (MT) and serratus anterior (SA) strengthening on pain, pain free grip strength, functional outcome, scapular muscles strength, scapular position and electromyographic (EMG) activity of lower trapezius, serratus anterior, extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) in individuals with chronic lateral epicondylalgia (LE). METHODS: Twenty six patients with chronic lateral epicondylalgia were recruited. Subjects were divided into two groups. Group 1 received scapular muscles strengthening along with conventional physiotherapy and Group 2 received only conventional physiotherapy for 6 weeks. Subjects were measured for pain (VAS), pain free grip strength, functional outcome (PRTEE), scapular muscle strength, scapular positioning (LSST) and EMG activity before and after the intervention.2 × 2 mixed ANOVA was used to investigate for main effect of time and group and interaction effect (time × group). RESULTS: The results revealed that there was statistically significant difference for time effect for all the outcome measures. In time × group interaction there was significant difference for all the outcome measures except scapular position (LSST3). Significant difference for group effect was observed in EMG activity of LT and ECRB. CONCLUSION: The scapular muscle strengthening should be used along with the conventional physiotherapy in individuals with chronic LE to improve pain, pain free grip strength, functional outcome, muscle strength, scapular position and muscle activity.