Mulligan's Mobilization Research Articles

“Investigating the combined effects of scapular-focused training and Mulligan mobilization on shoulder impingement syndrome” a three-arm pilot randomized controlled trial

ObjectivesTo assess whether the combination of scapular-focused training and mulligan mobilization (SFTMM) improves pain and proprioception compared to scapular-focused training (SFT) and a control group in female rock climbers with shoulder impingement syndrome (SIS).DesignThree-arm randomized controlled trial (RCT).SettingOutpatient setting.SubjectsIndividuals were randomly assigned to SFTMM, SFT alone, and control group.Interventions8 weeks of SFTMM and SFT.Main measuresOutcome measures were pain and proprioception.ResultsThe results revealed significant differences in pain scores and proprioception among female rock climbers with SIS who participated in SFTMM, SFT, and a control group (F(2, 32) = 81.01, p = 0.001, η2 = 0.83 for pain scores; F(2, 32) = 178.2, p = 0.001, η2 = 0.91 for proprioception scores). Post-hoc tests via the Bonferroni test indicated that both SFTMM and SFT significantly reduced pain levels (p = 0.001) and improved proprioception levels (p = 0.001) compared with the control group. There was no significant difference in pain scores and proprioception between the SFTMM group and the SFT group (p > 0.05).ConclusionsIn conclusion, the study indicates that SFTMM significantly reduces pain and improves proprioception in female rock climbers with SIS, as shown by notable changes compared to the control group. However, no statistically significant difference was found between the SFTMM (combined intervention) and SFT alone. Therefore, while the incorporation of SFT and MM shows promise; further research is needed to fully understand its long-term benefits and clinical implications.Ethical Code RegistrationThe study was approved at Ethics.research.ac.ir, code: IR.SSRC.REC.1402.170 on 2023-10-22.

EFFECTS OF MULLIGAN MOBILIZATION VERSUS SHACKLOCK NEURAL MOBILIZATION ON PAIN AND DISABILITY AMONG INDIVIDUALS WITH SCIATICA.

Background: Pain and disability are the most common issues reported among individuals with sciatica. Mulligan and shacklock neural mobilization are effective in reducing pain and disability among individuals with sciatica. Objective: The objective of the study was to find out the effects of mulligan mobilization versus Shacklock neural mobilization on pain and disability among individuals with sciatica. Methods: This was an Experimental study, 20 individuals with sciatica were recruited based on the inclusion criteria. Group A (n=10) received mulligan mobilization, pain neuroscience education and conventional exercises whereas Group B (n=10) received Shacklock mobilization, pain neuroscience and conventional exercises for 30-40 mins /1 session a day/4 day a week/4 week. Results: When comparing both the groups, NPRS scores were not statistically significant, but Group A showed significant results on ODI scores at the end of 4 weeks. Conclusion: Patients treated with mulligan mobilization show more significant improvement than those treated with Shacklock neural mobilization. Implications: The study shows the use of mulligan mobilization along with pain neuroscience and conventional therapy has significant results.

Effects of upper thoracic Mulligan mobilization on pain, range of motion and function in patients with mechanical neck pain: A randomized placebo-controlled trial.

This study aimed to assess the impact of Mulligan Reverse Natural Apophyseal Glides (RNAGS) applied to the upper thoracic region on pain, movement limitation, and function in individuals with mechanical neck pain. Conducted between January 2021 and May 2021, the study involved 69 participants randomly assigned to a sham group, physiotherapy group, and Mulligan group. A two-week, 11-session treatment program was administered with shared physiotherapy interventions and stretching exercises to all groups. The Mulligan group received additional mobilization with the Mulligan RNAGS technique. The sham group received sub-standard Mulligan mobilization. Outcome measures included Range of Motion (ROM), Visual Analogue Scale (VAS), and Neck Disability Index (NDI). No baseline differences were found in measurements among the groups. After the intervention, all groups showed increased ROM and decreased VAS and NDI scores (p<0.001). The Mulligan group exhibited significantly greater improvement in VAS, ROM, and NDI compared to other groups (p<0.001). The sham group demonstrated greater improvement in NDI and extension ROM compared to the physiotherapy group (p<0.001). Mulligan RNAGS technique in the upper thoracic region proved beneficial for pain relief, range of motion, and functionality in mechanical neck pain. Long-term effects warrant further exploration through population-based studies.

Effectiveness of Mulligan Mobilization Technique and Core Stabilization Exercises in Female Patients With Knee Osteoarthritis: A Randomized Controlled Single-Blind Study

ObjectivesThe aim of this study was to compare the effectiveness of the Mulligan mobilization (MM) technique and Core stabilization (CS) exercises added to the conventional physiotherapy (CP) program in female patients with knee osteoarthritis (KOA). MethodsThe study included 42 female patients diagnosed with bilateral KOA. Participants were randomly divided into 3 groups as CP group (mean age: 57.79 ± 7.43 years), MM group (mean age: 56.14 ± 6.95 years), and CS group (mean age: 54.36 ± 6.56 years). They were divided into 3 groups and treated 3 sessions per week for 4 weeks. Pain intensity, range of motion (ROM), and muscle strength were evaluated with visual analog scale, universal goniometer, and handheld dynamometer, respectively. Balance, aerobic capacity, and functional level were assessed with 30-second sit-to-stand test, 6-minute walk test, and Western Ontario and McMaster Universities Osteoarthritis Index. The quality of life of the participants was evaluated with the Nottingham Health Profile. ResultsAfter treatment, significant improvement was achieved in the all parameters evaluated in the groups (P < .05). CS was found to be more effective in reducing resting pain intensity than the other two treatment approaches (P = .001). It was observed that MM technique increased knee flexion ROM more (P = .001). There was no superiority of MM group and CS group over each other in balance, functional level, aerobic capacity, and quality of life assessments (P > .05). ConclusionOur study showed that CP, MM technique, and CS exercises were effective treatment approaches in the management of KOA in female patients. Results revealed that the MM technique was more effective in increasing knee flexion ROM, and the CS exercise was more effective in reducing resting pain intensity in female patients with KOA.

Manual therapy plus sexual advice compared with manual therapy or exercise therapy alone for lumbar radiculopathy: a randomized controlled trial.

The biopsychosocial approach to managing low back pain (LBP) has the potential to improve the quality of care for patients. However, LBP trials that have utilized the biopsychosocial approach to treatment have largely neglected sexual activity, which is an important social component of individuals with LBP. The objectives of the study are to determine the effects of manual therapy plus sexual advice (MT+SA) compared with manual therapy (MT) or exercise therapy (ET) alone in the management of individuals with lumbar disc herniation with radiculopathy (DHR) and to determine the best sexual positions for these individuals. This was a single-blind randomized controlled trial. Fifty-four participants diagnosed as having chronic DHR (>3 months) were randomly allocated into three groups with 18 participants each in the MT+SA, MT and ET groups. The participants in the MT+SA group received manual therapy (including Dowling's progressive inhibition of neuromuscular structures and Mulligan's spinal mobilization with leg movement) plus sexual advice, those in the MT group received manual therapy only and those in the ET group received exercise therapy only. Each group received treatment for 12 weeks and then followed up for additional 40 weeks. The primary outcomes were pain, activity limitation, sexual disability and kinesiophobia at 12 weeks post-randomization. The MT+SA group improved significantly better than the MT or ET group in all outcomes (except for nerve function), and at all timelines (6, 12, 26, and 52 weeks post-randomization). These improvements were also clinically meaningful for back pain, leg pain, medication intake, and functional mobility at 6 and 12 weeks post-randomization and for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at 6, 12, 26, and 52 weeks post-randomization (p<0.05). On the other hand, many preferred sexual positions for individuals with DHR emerged, with "side-lying" being the most practiced sexual position and "standing" being the least practiced sexual position by females. While "lying supine" was the most practiced sexual position and "sitting on a chair" was the least practiced sexual position by males. This study found that individuals with DHR demonstrated better improvements in all outcomes when treated with MT+SA than when treated with MT or ET alone. These improvements were also clinically meaningful for sexual disability, activity limitation, pain catastrophizing, and kinesiophobia at long-term follow-up. There is also no one-size-fits-all to sexual positioning for individuals with DHR.

The Impact of Ankle Mobilization Techniques on Static Stability in Individuals With Acute Inversion Ankle Sprain: A Randomized Clinical Trial

ObjectiveThe purpose of the study was to compare the impact of the mobilization techniques and mobilization with movement techniques on static balance in individuals with acute inversion ankle sprain. MethodsVolunteers with acute inversion ankle sprain (N = 40) were equally and randomly assigned to 2 groups. Participants in intervention group I received the Mulligan mobilization with movement techniques, whereas participants in intervention group II underwent the Maitland mobilization techniques. Each participant received the intervention every other day for 2 consecutive weeks. To assess static balance, participants assumed a single-leg stance on the affected leg at the center of a force plate with eyes open or closed plate for 20 seconds. The displacement, velocity, and area of the center of pressure were recorded 1 day before and after the intervention. ResultsThe velocity of the center of pressure in the anterior-posterior direction was significantly reduced only in group I during eyes open (P = .043) and closed (P = .004). However, the displacement of the center of pressure in the anterior-posterior direction was significantly decreased in both group I (P = .024) and group II (P = .028) with eyes open. No significant changes were found in the area of the center of pressure in either group during eyes open or closed (P > .053). ConclusionsBoth Mulligan's and Maitland's approaches significantly improved sway displacement. For the individuals with acute inversion ankle sprain who were included in this study, the Mulligan technique were more effective in improving static balance indicators compared to the Maitland technique. Clinical TrialThe study was then registered in the Iranian Registry of Clinical Trials (17/02/2019) (IRCT20190108042292N2).

The Clinical Significance of Mulligan's Mobilization with Movement in Shoulder Pathologies: A Systematic Review and Meta-Analysis.

Background: Mulligan's mobilization with movement (MWM) is a manual therapy technique designed to address musculoskeletal pain and joint mobility. Despite immediate reported improvements by patients, the clinical significance of MWM compared with other interventions remains uncertain. Objective: To assess the clinical effectiveness of MWM for shoulder pathologies compared with other treatment methods. Methods: The databases PubMed, Web of Science, Cochrane Library, Scopus, and the Physiotherapy Evidence Database (PEDro) were searched up to June 2024. Inclusion criteria were limited to randomized controlled trials published in English and Turkish languages, focusing on the MWM technique for shoulder pathologies. Two independent reviewers evaluated methodological quality based on the PEDro scale. Outcome data were analyzed for pain, function, and range of motion (ROM) using SPSS Statistics 29.0. Results: Twenty-seven studies (1157 participants) were included. MWM demonstrated statistical superiority in function (MD = -11.24, 95% CI: [-18.33, -4.16], p = 001) and shoulder flexion and abduction ROM compared with other mobilization techniques. There was a significant MD in pain intensity, which was -1.55 cm (95% CI: [-2.60, -0.51], p = 0.00), with high heterogeneity (I2 = 93%), favoring MWM in comparison with control group. MWM was significantly better for shoulder abduction ROM in comparison with physical therapy interventions (MD = -14.44, 95% CI: [1.98, 26.90], p = 0.02) with high heterogeneity (I2 = 90%) and control group (SMD = 56.67, 95% CI: [7.71, 111.63], p = 0.02) with high heterogeneity (I2 = 96%). However, clinical significance was not consistently achieved. Conclusions: Although some statistical significance was found when comparing MWM with other her treatment methods, it was observed that most of the statistically significant data did not reach clinical significance. Upon closer examination, outcome measures that showed clinical significance, either the interventions in the comparison group were inadequate, not evidence-based, or the improvements within the group were not logical.

Effects of Floss Band with Strengthening Exercise and Mulligan Mobilization on Knee Static and Dynamic Balance in Adults

Effects of Floss Band with Strengthening Exercise and Mulligan Mobilization on Knee Static and Dynamic Balance in Adults

The effects of ankle mulligan mobilisation in children with cerebral palsy: A randomized single blind control study.

To assess the impact of range of motion changes before and after Mulligan mobilisation with ankle movement interventions on the daily lives of children with diplegic cerebral palsy. The single blind randomised controlled study was conducted from July 30, 2022, to January 10, 2023, at 3 rehabilitation centres in Hebron, Palestine, after approval from the ethics review committee of Eastern Mediterranean University, Northern Cyprus, and comprised children with cerebral palsy, who were randomised into intervention group IG and control group CG. All the subjects received regular physiotherapy sessions, overseen by their parents, while those in group IG received mobilisation with ankle movement treatment 3 times per week for 4 weeks. Post-intervention assessment of ankle range of motion, balance, functional performance and quality of life was done using a goniometer, the timed up and go test, 88-item gross motor function measure, 6-minute walk test and the cerebral palsy quality of life questionnaire. Data was analysed using SPSS 24. Of the 64 patients, 40(63%) were girls, and 24(37%) were boys. The overall age range was aged 4-12 years. There were 32(50%) patients in each of the two groups. Mobilisation with movement had a significant effect on active and passive range of motion for the left and right ankles (p<0.05) as well as on balance, gross motor function and quality of life (p>0.05). However, mobilisation with movement had no significant effect on the the distance covered during the 6-minute walk test (p>0.05). Mobilisation with movement had a significant impact on active and passive ankle range of motion, balance and quality of life in diplegic children with cerebral palsy, but it had no impact on gait function. The study was registered at the United States National Institutes of Health (ClinicalTrials.gov) with registration number NCT05500924.

Comparison of Mulligan Mobilization with Movement and Progressive Strengthening Exercises in Patient with Lateral Epicondylitis

Background: Lateral epicondylitis, commonly known as tennis elbow, is the most prevalent cause of elbow pain. Both Mulligan Mobilization with Movement (MWM) and Progressive Resistive Exercises (PRE) have shown effectiveness in treating lateral epicondylitis individually. This study aims to compare the effects of these two interventions to determine which is more effective in managing lateral epicondylitis. Objective: To compare the effects of Mulligan Mobilization with Movement and Progressive Resistive Exercises in relieving pain, improving functional disability, and enhancing pain-free grip strength in patients with lateral epicondylitis. Methods: A randomized clinical trial was conducted on 33 patients with symptomatic tennis elbow from July 2020 to January 2021 at the Bone and Joint Center and Khyaban Medical Center. Participants were randomly assigned to Group A (n=16) receiving Mulligan Mobilization with Movement and conventional physiotherapy, and Group B (n=17) receiving Progressive Resistive Exercises and conventional therapy. Patients were assessed using the Visual Analogue Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and hand dynamometer to measure pain intensity, functional status, and grip strength at baseline, after 5 sessions, 10 sessions, and at a 6-week follow-up. Data were analyzed using SPSS version 25. Results: Both groups showed significant improvements within group analyses. Group A showed a more substantial reduction in VAS scores and PRTEE scores, with median VAS scores decreasing from 7 to 2 (p=0.001) and PRTEE scores improving from 41 to 8 (p=0.001). Group B demonstrated greater improvements in pain-free grip strength, with median values increasing significantly at all time points (p&lt;0.05). Between-group analysis revealed that Group A had more significant improvements in VAS and PRTEE scores, while Group B had more significant improvements in pain-free grip strength. Conclusion: Mulligan Mobilization with Movement was more effective in reducing pain and improving functional status in patients with lateral epicondylitis compared to Progressive Resistive Exercises. However, Progressive Resistive Exercises were more effective in enhancing pain-free grip strength. These findings suggest the importance of tailored treatment approaches based on individual patient needs.

Outcomes of Mulligan Concept Applications in Obese Individuals with Chronic Mechanical Low Back Pain: A Randomized Controlled Trial.

Various treatment modalities have been employed for mechanical low back pain (MLBP), but evidence of their efficacy varies greatly. Objectıve: This randomized controlled trial aimed to assess the outcomes of Mulligan concept applications, including sustained natural apophyseal glides (SNAGS) and natural apophyseal glides (NAGS), in obese patients with MLBP. The study, conducted between January 2021 and June 2022 at a tertiary hospital, involved randomizing patients into two groups. Both groups underwent six sessions of stretching and strengthening exercises every other day. The Mulligan group received additional intervention with SNAG and NAGS techniques. Measurements were made regarding the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score and range of motion (ROM) for the patients' MLBP level. Post-interventions, both groups exhibited positive changes in flexion ROM, extension ROM, right and left rotation ROM, right and left lateral flexion ROM, VAS score, and ODI score compared to pre-intervention (p < 0.001 for both groups and variables). The Mulligan group showed a higher increase in ROM and a more significant decrease in VAS and ODI scores. Conclusıons: Mulligan mobilization techniques prove significantly beneficial for enhancing ROM in all directions, reducing pain levels, and alleviating disability in obese individuals with MLBP.

The effects of the addition of Mulligan mobilization with movement to exercise on elbow pain and function associated with lateral elbow tendinopathy

BackgroundMulligan mobilization with movement (MWM) and eccentric exercise (EE) have been shown to be effective for the treatment of chronic lateral elbow tendinopathy (LET). However, the addition of MWM to EE effects on LET remained unknown. The objective of the study was to determine the effects of adding of Mulligan mobilization with movement to eccentric exercise for the treatment of LET. MethodsIn this quasi-experimental study, thirty participants with unilateral LET were assigned into two groups: 15 in MWM (received MWM + EE) (7 M and 8 F, mean age 36.8 ± 8.3 years) and 15 in EE (9 M and 6 F, mean age 46 ± 8.1 years). Both groups received education about painful activities and eccentric exercise, while the MWM group received MWM with the same eccentric exercise as the EE group. The visual analog scale (VAS) and the patient-rated tennis elbow evaluation (PRTEE) were used to assess pain and upper limb function, respectively, at baseline and at the end of 4 weeks. The data was analyzed using an independent t-test and a paired t-test. ResultsThere was no significant difference (p > 0.05) between groups at baseline. At the end of 4 weeks, significant and clinically meaningful improvements in pain and function were observed for both groups (p < 0.001); however, MWM group showed much better results in VAS (p < 0.001, d = 1.3) and PRTEE (p < 0.001, d = 5.2) ConclusionThis study showed that adding MWM to eccentric exercise resulted in enhanced pain reduction and improved function of the upper limb.

Effect of Mulligan Mobilization on Active Trigger Points in Cervical Radiculopathy

Effect of Mulligan Mobilization on Active Trigger Points in Cervical Radiculopathy

A Review on Treatment Approaches for Chronic Low Back Pain via Mulligans Movement With Mobilization and Physical Therapy

Abstract One of the main causes of functional impairment is low back pain. Every one of all ages can have low back discomfort, and there are several ways to treat this condition. Physiotherapy's manual therapy is a specialist field that treats neuromuscular discomfort. The Mulligan technique, Maitland mobilisation technique, Active release technique, and many more are examples of manual therapy procedures. The primary focus of manual therapy is on the joint's osteokinematics and arthrokinematics. It is one of the primary methods for treating low back pain. Any ligamentous strain, muscular pathology, spinal dysfunction, or sacroiliac dysfunction can all produce low back discomfort. It is important to determine the reason of the low back discomfort and treat it appropriately. This review leads us to the conclusion that mobility combined with Mulligan mobilisation is a useful strategy for lowering low back pain. Checking the efficacy of manual therapy techniques in treating chronic low back pain requires more research

Therapeutic effects of mobilization in alleviating pain and improving shoulder mobility in adhesive capsulitis – A systematic review

Frozen shoulder (FS) is a painful clinical disease that lasts over three months and affects 3–5% of the general population. The main goal of this review was to show how mobilization techniques can affect FS treatment compared to other physiotherapy options. A systematic review of randomized controlled studies from CINAHL, MEDLINE, AMED, and PubMed published after 2010. Studies that included patients 18 or older with FS, but no other underlying systemic disorders were eligible. The review focused on two primary outcomes: Pain levels and how effectively patients could move their shoulders. The quality of the studies was assessed using the physiotherapy evidence database (PEDro) technique. Six randomized controlled studies with a PEDro score of 5/10 that met the study requirements were included. The pain was reduced in three of the five investigations with P &lt; 0.05, whereas the remaining studies yielded neutral findings in lowering pain in patients with FS. All of the individuals’ range of motion (ROM) was evaluated. With P &lt; 0.05, four of the six trials showed an improvement in shoulder ROM. Bending, straightening, moving arms away from the body, bringing them back in, internal rotation, and external rotation were all assessed and shown to be significant with P ≤ 0.05. Most studies suggested that patients, who have received mobilization treatment, experienced positive improvements. Techniques such as Mulligan mobilization, scapular mobilization, passive mobilization, and angular joint mobilization have proven effective in addressing pain and improving the ROM in individuals with FSs.

Efficacy of PowerBall Versus Mulligan Mobilization With Movement on Pain and Function in Patients With Lateral Epicondylitis: A Randomized Clinical Trial.

Background Lateral epicondylitis (LE), sometimes referred to as tennis elbow or lateral elbow tendinopathy (LET), is one of the most common repetitive stress disorders in the elbow joint. Often, this involves the attachment of the extensor carpi radialis brevis muscle. This study's primary focus is on treating people with LE, a condition that causes repetitive movements of the upper extremities. There is currently no research on how PowerBall gadget workouts affect the function and pain of individuals with lateral epicondylitis. Exercises using the "PowerBall device," which appliesboth intrinsic and extrinsic pressure to the wrist, elbow, and shoulder muscles, are thought to be beneficial forms of resistance training. It has been shown that there are improvements in strength, function, range of motion (ROM), discomfort, and quality of life (QOL). On the other side, it has been demonstrated that LE patients have reduced discomfort while using Mulligan Mobilization with Movement (MMWM). Methods The 50 patients with LE were split into two groups for the single-blinded, randomized clinical study after baseline assessment and randomization: Group A was the intervention group, and Group B was the conventional group. The "PowerBall device" exercise was provided to participants in Group A, and MMWM was given to those in Group B. Both groups can benefit from basic workouts and ultrasonography by following the prescribed routine. Quantification of pain, function, grip strength, and range of motion was done at the start and finish of therapy using the Visual Analogue Scale (VAS), Patient Rated Tennis Elbow Evaluation (PRTEE), portable dynamometer, and goniometer. Results After therapy, both groups showed considerable improvement (p<0.05). Both descriptive and inferential statistics were employed in the data analysis. Numerous statistical tests were employed, such as the student's paired and unpaired t-test and the chi-square test. From a statistical and clinical perspective, Group A's outcomes were more significant. On the visual analog scale, there was a decrease in pain intensity for wrist and elbow mobility at rest (p<0.0003), activity (p<0.003), PRTEE (p<0.001), grip strength (p<0.03), and range of motion (p<0.01). Both groups' assessments after rehabilitation indicated increases in pain and function; however, Group A (0.03) benefited more and saw early success with the PowerBall device. Conclusion Findings show that a three-week program incorporating resistance training exercises mediated by a "PowerBall device" enhances upper limb performance beyond traditional exercise treatment and increases grip strength, wrist extension strength, internal and external rotator concentric and eccentric strength. The findings and observations indicate that both groups have significantly improved.

Efficacy of Mulligan MWMs along with Conventional Physical Therapy in Knee Osteoarthritis

Background: Knee osteoarthritis is a prevalent degenerative joint disease that impairs mobility and causes significant pain, particularly in the aging population. Conservative management, including physical therapy, remains a cornerstone of treatment. The addition of Mulligan Mobilization with Movement (MWM) to conventional therapy has been proposed to improve outcomes, though its efficacy had not been robustly quantified. Objective: The objective of this study was to compare the efficacy of Mulligan MWM in conjunction with conventional physical therapy to conventional physical therapy alone in reducing pain and stiffness and improving functional outcomes in patients with grade 2 knee osteoarthritis. Methods: This randomized clinical trial included 28 participants with grade 2 knee osteoarthritis, randomly allocated into two groups: one receiving Mulligan MWM alongside conventional physical therapy and the other receiving only conventional physical therapy. The intervention lasted one month, with assessments conducted at baseline, two weeks, and four weeks using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as outcome measures. Statistical analysis was performed using SPSS version 25. Results: The MWM plus physical therapy group exhibited a greater reduction in VAS scores (baseline: 6.71, SD 1.729 to week 4: 2.21, SD 1.051) compared to the physical therapy alone group (baseline: 7.14, SD 1.562 to week 4: 3.86, SD 0.663), with a significant mean difference (P&lt;0.001). Similarly, WOMAC scores for pain, stiffness, and physical function significantly improved in the MWM group compared to the physical therapy group at week 4 (Pain: 2.79 vs. 6.86, Stiffness: 1.14 vs. 3.36, Function: 9.79 vs. 27.57, all P&lt;0.001). Conclusion: Mulligan MWM combined with conventional physical therapy was more effective than conventional physical therapy alone in reducing pain, stiffness, and improving functional outcomes in patients with grade 2 knee osteoarthritis. These results support the inclusion of MWM in the management of knee osteoarthritis.

Unveiling the Efficacy of Physiotherapy Strategies in Alleviating Low Back Pain: A Comprehensive Review of Interventions and Outcomes.

Low back pain (LBP) presents a significant burden globally, affecting individuals of all ages, but it is more common in adults aged 30-60 years oldand demographics including race, ethnicity, and socioeconomic status. Physiotherapy interventions are commonly employed to manage LBP due to their non-invasive nature and potential for addressing underlying biomechanical dysfunctions. This comprehensive review aims to evaluate the efficacy of various physiotherapy strategies in alleviating LBP, considering a range of interventions and their associated outcomes. Through a thorough examination of existing literature from January 2017 to October 2023, this review synthesises evidence on the effectiveness of interventions such as manual therapy, exercise therapy, electrotherapy modalities, and education-based approaches. The review also scrutinizes the comparative effectiveness of different physiotherapy modalities and their suitability for specific patient populations, considering factors such as chronicity, severity, and underlying pathology. By critically evaluating the evidence base, this review aims to provide insights into the most effective physiotherapy strategies for alleviating LBP, chronic low back pain (CLBP)and chronic nonspecific low back pain (CNLBP) and guiding clinical practice towardevidence-based interventions. The Visual Analogue Scale and Numerical Pain Rating Scale for pain, Oswestry Disability Index andRoland-Morris Disability Questionnaire for disability, Modified-Modified Schober Test for measurement of lumbar flexion and extensionand static and dynamic balance for assessing postural stability and balance were among the measures used to foresee enhancements in pain, disability, balance, and LBP symptoms. Twenty-one studies that fulfilled the criteria for inclusion (aged 20 to 50 years and of both genders) were added to the review. Exercises for core stability, strengthening, orthosis (a medical device designed to support, align, stabilise, or correct musculoskeletal structures and functions), transcutaneous electrical nerve stimulation, heat massage therapy, interferential current (a form of electrical stimulation used in physical therapy), Mulligan's mobilization (a manual therapy technique), low-level laser therapy, and McGill stabilization exercises (core exercises) were among the therapeutic strategies. The McKenzie method (back exercises), ultrasound, sensory-motor training, Swiss ball exercises, and other techniques reduced pain and enhanced strength, balance, and ease of daily activities. Every therapeutic approach has an impact on recovery rates ranging from minimal to maximal. Conventional physical therapy is less effective than most recent advancedtechniques like mobilisation and exercises. In summary, the integration of manual techniques, orthoses and alternative intervention strategies with conservative therapeutic approaches can effectively alleviate pain, enhance function and yield better overall outcomes. To get more information about the optimal dosage, therapeutic modalitiesand long-term effects of these treatments, more admirable research is required. This paper aims to expand the scientific discourse by exploring non-traditional physiotherapy interventions and assessing their efficacy in light of the rigorous standards set forth by the latest WHO guidelines.

The effect of mulligan mobilization technique application in addition to conventional physiotherapy on pain and joint range of motion in people with neck pain

BackgroundTo evaluate the effect of the Mulligan mobilization technique on pain intensity and range of motion in individuals with neck pain. MethodsForty individuals with mechanical neck pain were enrolled in the study. The patients were randomly divided into 2 groups and a total of 10 sessions of treatment were administered to all 2 groups for 2 weeks, 5 days a week. Mulligan mobilization technique, electrophysical agents, active range of motion, and stretching exercises were carried out in the Mulligan group. In contrast, only electrophysical agents and exercises were applied to the conventional physiotherapy group. Range of motion (ROM) of the neck, Visual Analog Scale (VAS), Neck Pain and Disability Scale (NPDS), and Short-Form 36 Health Survey (SF-36) were used for evaluation. ResultsStatistical analyses were done to compare the amounts at the baseline and immediately after treatment. Statistically significant improvements were found in the post-treatment ROM, VAS, NPDS values in both groups (p < 0.05). When the differences were compared, the results of the Mulligan group were significantly better than the conventional physiotherapy group (p < 0.05). There was no significant difference between the groups in terms of SF-36 parameters (p > 0.05). ConclusionsThis study showed that the Mulligan mobilization technique plus conventional physiotherapy is more effective than conventional physiotherapy in increasing joint range of motion, reducing pain, and reducing neck disability. Trial registratonClinicalTrials.gov (NCT05074576).

The Efficacy of Muscle Energy and Mulligan Mobilization Techniques for the Upper Extremities and Posture after Breast Cancer Surgery with Axillary Dissection: A Randomized Controlled Trial.

Background: Breast cancer surgeries affect the upper extremities and posture. This study aimed to examine the efficacy of muscle energy and Mulligan mobilization techniques on the upper extremities and posture after breast cancer surgery with axillary dissection. Methods: A total of 90 female participants who had undergone breast cancer surgery with axillary dissection were recruited and randomly assigned to three groups. Group A received a combination of the Mulligan and muscle energy techniques, while Groups B and C received either the Mulligan or muscle energy techniques for six weeks, respectively. The study measured the shoulders' range of motion, posture, and upper-extremity disabilities. Outcome measurements were taken at three different time points: baseline, post-intervention, and at eight-week follow-up. Results: All the interventions significantly improved the study outcomes. The combination of the Mulligan and muscle energy techniques was significantly better than a single intervention. Mulligan mobilization was superior to the muscle energy techniques in terms of improving the shoulders' range of motion and disability. The interventions showed a significant effect pre-post-treatment and pre-follow-up but not post-follow-up. Conclusions: The Mulligan mobilization and muscle energy techniques have been found beneficial in improving the postural changes and shoulder outcomes after breast cancer surgery with axillary dissection. The superior effectiveness of the combined interventions points out the importance of integrating multiple therapeutic approaches for optimal outcomes. Regular examination and long-term follow-up assessment are important for studying the effect of rehabilitation interventions in people after the late stages of breast surgery.