Efficacy of McKenzie, Maitland Mobilisation and Myofascial Release in Chronic Low Back Pain

Abstract

Objective: To compare the effectiveness of Myofascial Release, Mc Kenzie and Maitland Mobilisation in Chronic Low back Pain and find out the effects of Myofascial Release, Mc Kenzie and Maitland Mobilisation in Chronic Low back Pain. Background: Low back pain is defined as the pain that occurs in an area with boundaries between the lowest rib and the crease of the buttocks. It is one of the most common complain of working-age population. Low back pain is associated with deconditioning of spine and trunk due to lack of core strength and stability in which 60-80% of general population suffer with high recurrence rates of 60 - 85% within following three years. The global prevalence of LBP as 7.3%. Activities that are required for daily living are affected because of LBP. The significance of disability is created because of LBP. The lumbosacral, sacroiliac and lumbar regions are the main regions of LBP. Pain in the back region that lasts for more than three months is called chronic lower back pain (CLBP). Lower?back pain (LBP) is seen in all age groups. Half of the people encounter back pain in a year and nearly three-fourths of the population account for LBP in their lifetimes. It is one of the most disabling factors often preventing sports person for participation in sporting activities. In United States, the workers compensation claims account for about one fourth of all claims and one third of total compensation costs. It results in about 40% of absences from work. In total spinal pain cases low back pain accounts for 60-70%.Chronic Low back pain is the pain that persists longer than the expected time period for healing, with a duration of more than three months. The natural course of most low back pain is of self-limiting in nature, with vast majority of individuals improving within six weeks or less. Study design: Experimental study Methods: 51 subjects were selected through convenient sampling. All the subjects who were diagnosed with chronic low back pain from Orthopaedics OPD was referred to physiotherapy department and was screened and assessed according to inclusion and exclusion criteria. The eligible subjects were approached with proposal of the study. Aim and procedure of the study was explained to the subject and a written informed consent was taken from them in their preferred language. At first the demographic data (age, sex, duration) was collected forever subject. Then the baseline data (pre intervention) of CLP intensity, functional disability was taken before commencement of the study. Then the subjects were randomly allocated each 17 subjects. A final data of pain intensity, functional disability was recorded. Results: For all the outcome measures, no significant difference results were found for all three techniques. Whereas, Mc Kenzie techniques is the most effective and the least effective is Maitland Mobilisation. Mean Improvement calculated as Pre- post values of VAS and RMQ scores at follow-up on 7th and 14th day was compared between the 3 techniques. Its significance was tested by testing whether the 95% CI of the mean improvement included 0 or not. Mckenzie techniques howed maximum improvement 4.68 (2.29, 7.07) on Day 7th and Maitland mobilisation the least improvement, 1.56(0.95, 2.93). Improvement by all techniques was significant at 95% CI using paired t test. However, on day 14th McKenzie showed maximum improvement 5.56(2.72, 7.07)) Maitland mobilization remaining the least effective. Conclusion: LBP is a common condition and all age groups are facing it. Pain can be due to various causes and the line of treatment depends upon the cause of pain. In this review, we found out that LBP is a condition everyone is facing. Mc Kenzie is a better treatment approach over other two techniques to reduce chronic LBP. Pain and disability were the points considered while concluding. LBP affects the quality of life and to maintain or improve the quality of life strengthening the muscles plays an important role. This review gives a brief about the treatment methods available for treating CLBP clinically. Hence physiotherapy treating subjects with chronic low back pain may choose any one technique but Mc Kenzie Technique is the most effective technique for pain and for functional disability in CLBPis the most effective. However sufficient experience and expertise is necessary. Key words: Chronic Low Back Pain, Mc Kenzie, Maitland Mobilisation, Myofascial Release, VAS, RMQ