Comparative Effects Of Maitland And Mulligan Spinal Mobilizations Along With Canal Enlargement Exercises In Patients Of Lumbar Spinal Stenosis

Abstract

Background: About 90% of individuals faced the low back pain in their life time and the spinal stenosis of lumber spine is one the main causes for the radiating symptoms along the chronic low back pain. Stretching, strengthening, traction and electrotherapy were commonly practiced interventions in lumbar stenosis. But spinal mobilization has a great impact on symptoms severity and thus, reducing the disability.

Objective: To compare the effects of Maitland central postero anterior mobilization and Mulligan transverse mobilization along with canal enlargement exercises in patients of lumber Spinal Stenosis

Methods: A study was randomized control trail that was conducted at Allama Iqbal Memorial Teaching Hospital, Sialkot. A total of 38 patients meet the inclusion criteria. The patients were assigned to one of the two groups randomly in group A and group B. Both groups received the conventional treatment and canal enlargement exercises. Additionally, Group A received the Maitland central posteroanterior mobilization while Group B received the Mulligan spinal transverse mobilization. Treatment was given for 3 weeks and 4 sessions per week. Outcome measures include the Numeric pain rating scale (NPRS), Modified Oswestry disability index (MODI) and Swiss spinal stenosis score (SSSS) to measure pain, disability and functional activities at the start day and at end of 3^rd week of the treatment sessions.

Results: In each group 19 participants were allocated. Both groups have same baseline characteristics i.e. age, BMI, gender distribution. Intragroup comparison using the paired sample t test and Wilcoxon signed-rank Test shows the significant differences (p <0.05) in decreasing pain, disability and improves functional status. Intergroup comparison using the independent sample t test for MODI and SSSS revealed the significant difference between the two groups (p <0.05) in reduction of disability and improves the functional activities. Intergroup comparison using the Mann Whitney U test for NPRS shows no significant differences (p>0.05) in both groups in reducing the level of pain.

Conclusion: A study concludes that Maitland mobilizations and Mulligan mobilizations, both approaches were similar in their effectiveness in decreasing pain but Maitland mobilization showed more significant difference to alleviate the disability, functional restriction in lumbar spinal stenosis and settle down the symptoms. The findings are favorable regarding the inclusion of Maitland techniques in addition to the canal enlargement exercises to manage LSS completely.