Mulligan's Mobilization Research Articles

The effects of manual therapy and exercises on pain, muscle strength, joint health, functionality and quality of life in haemophilic arthropathy of the elbow joint: A randomized controlled pilot study.

Effective physiotherapy interventions are required for haemophilic arthropathy (HA) of the elbow due to its biomechanical differences and contribution to upper limb functionality. To investigate the effects of manual therapy & exercises on bleeding frequency, pain, range of motion (ROM), strength, joint health, functionality and quality of life (QoL) in HA of the elbow. Seventeen participants with HA of the elbow were randomized as Manual Therapy & Exercises Group (MTEG=9) and Home Exercises Group (HEG=8). Soft tissue mobilization, joint traction (grade I-II) and Mulligan's mobilization with movement as manual therapy, and stretching/strengthening exercises were applied to MTEG, while HEG had only same exercises as home programme. The interventions lasted 3days/weekly for 5weeks. Bleeding frequency was evaluated with patients' records; pain with Numeric Pain Scale; ROM with goniometer; strength with digital dynamometer; joint health with HJHS; functionality with Quick-Disability of Arm, Shoulder and Hand questionnaire; and QoL with Oxford Elbow Score. Bleeding frequency and activity pain were decreased, while elbow ROMs and flexor strength were increased in MTEG (P˂0.05). Also significantly improvements were seen in joint health, functionality and QoL in MTEG. HEG showed improvements in activity pain, QoL and some ROMs. MTEG had better results in ROMs, joint health and functionality (P˂0.05). Manual therapy & exercises may be used without causing bleeding and pain to increase the functionality, joint health and QoL, and is superior to home exercise for joint health and functionality. Home exercises may be ameliorated in pain, QoL and some ROMs.

A comparative study on the effectiveness of Mulligan mobilization versus Positional release therapy technique in patients with Adhesive capsulitis

Adhesive capsulitis is a painful condition in which the movement of the shoulder becomes limited and functional activity is affected. Adhesive capsulitis occurs when the shoulder joint capsule become thick, stiff and inflamed. The aim of the study is to compare the effectiveness of Mulligan movement with mobilization versus Positional release technique on shoulder range of motion and functional activity in patients with adhesive capsulitis. 30 patients were randomly divided into two groups. Group A (N = 15) received Mulligan mobilization technique and Group B (N = 15) received positional release therapy. The shoulder range of motion (Abduction, External rotation, Internal rotation) was measured by goniometer, the functional activity by SPADI questionnaire. The results showed that significant differences in shoulder ROM Abduction (t = 14.18, p = 0.000), Internal rotation (t = 13.80, p = 0.000), External rotation (t = 15.87, p = 0.000) and SPADI questionnaire (t = 13.94, p = 0.000) were observed in group A patients when compared to group B. In conclusion the Mulligan mobilization technique was effective to improve the shoulder ROM and reduce functional disability in patients with adhesive capsulitis compared to Positional release technique.

Comparing Mulligan Mobilization and Neural Mobilization Effects in Patients with Cervical Radiculopathy

Background Mulligan mobilization and neural mobilization have already made a mark and have been found effective in reducing pain disability and in improving range of motion in patients with cervical radiculopathy. Objective The present study was intended to compare the effects of Mulligan mobilization versus neural mobilization in cervical radiculopathy.Methods Thirty patients with cervical radiculopathy were conveniently assigned to two groups ndash Group A n15 were treated with Mulligan mobilization while Group B n15 were treated with neural mobilization. Intermittent cervical traction was used as a common treatment for both the groups. Treatment dosage for both groups was seven sessions or one week. Neck disability functional level and range of motion before and after the treatment program were evaluated by using Neck Disability Index questionnaire Patient Specific Functional Scale questionnaire and Goniometer respectively.Results In Group A amp Group B significant improvement in condition existed within the groups. There was a significant reduction in neck disability increase in functional level and increase in ROM following Mulligan and neural mobilizations. Though patients who received neural mobilization did better than patients who received Mulligan there was no significant difference between the groups. PSFS p0.572NS NDI p0.269NS ROM Flexion p0.776NS extension p0.302NS lateral flexion ndash right p0.282NS lateral flexion ndash left p0.877NS side rotation ndash left p0.72NS were noted.Conclusion Neural mobilization showed better results than Mulligan mobilization in the management of cervical radiculopathy. However there was no significant difference between the groups.Keywords Cervical radiculopathy Mulligan mobilization Neural mobilization Neck disability Functional level.

Efficacy of manual therapy on psychological status and pain in patients with neck pain. A randomized clinical trial.

Objectives:To compare the effectiveness of Maitland versus Mulligan mobilization techniques on pain, functional disability, and psychological status in patients with neck pain.Methods:Forty-four patients with nonspecific neck pain were randomly assigned to the Maitland group (n=22 patients received Maitland therapy [central or unilateral postero-anterior pressure] for 2 sessions/week for 3 weeks) and Mulligan group (n=22 patients received Mulligan sustained natural apophyseal glides for 2 sessions/week for 3 weeks). This study was conducted at the Rehabilitation Clinic, King Abdulaziz Hospital, Jeddah, Kingdom of Saudi Arabia between December 2016 to May 2017. The outcome measures were the numeric pain rating scale score, neck disability index score, beck depression inventory score, State-trait anxiety inventory score, fear avoidance beliefs questionnaire, and pain catastrophic scale results. The independent t-test, Shapiro-Wilk test, and paired t-test were used in data analysis.Results:There were significant improvements in mean values of the numeric pain rating scale, neck disability index, beck depression inventory, state-trait anxiety inventory scores, and pain catastrophic scale results after the interventions in both groups (p<0.05, all except fear avoidance beliefs results in mulligan group p>0.05), and there were no significant differences in mean values between the groups (p>0.05).Conclusion:In patients with nonspecific neck pain, Maitland and Mulligan mobilization techniques have positive effects on neck pain, functional disability, and selected psychological features with no significant difference between them.

Subakromiyal Ağrı Sendromunda Mulligan Hareketle Mobilizasyon Yöntemi ve Konvansiyonel Rehabilitasyon Protokolünün Omuz Ağrı ve Fonksiyonları Üzerine Olan Etkilerinin Karşılaştırılması: Prospektif Randomize Tek Kör Çalışma

Subakromiyal Ağrı Sendromunda Mulligan Hareketle Mobilizasyon Yöntemi ve Konvansiyonel Rehabilitasyon Protokolünün Omuz Ağrı ve Fonksiyonları Üzerine Olan Etkilerinin Karşılaştırılması: Prospektif Randomize Tek Kör Çalışma

Comparison of two different techniques of mobilization in mechanical neck pain with decrease temporomandibular joint mobility

Pain in the anatomic region of neck is known as mechanical neck pain which is primarily caused by overuse of a normal anatomical structure, secondary to injury and deformity of anatomical structure. Also, mechanical neck pain can be defined as generalized neck pain provoked by sustained neck postures, neck movement, and pain on palpation of cervical musculature without pathologies. Restrictions of the neck movement occur and forced movement on the neck may worsen the pain. Mechanical neck pain is also known as nonspecific neck pain. It is a common complaint which affects 45-54% of the general population. The incidence of neck pain is higher in women (15%) than men (9%). High prevalence of neck pain was reported in desk job workers. 1-year prevalence of neck pain and work-related neck pain was reported as 43.3% and 28.3%. To compare the effect of Maitland and Mulligan mobilization with myofascial release on mechanical neck pain with decreased temporomandibular joint mobility. Total 45 subjects were selected and divided into three groups by random sampling method. This study concludes that Maitland mobilization and Mulligan mobilization are effective in mechanical neck pain with TMJ disability.

Comparing the effectiveness of mulligan mobilization versus cyriax approach in the management of patients with subacute lateral epicondylitis

Abstract&#x0D; Objective: To determine the effectiveness of Mulligan mobilisation versus Cyriax approach in the management of patients with subacute lateral epicondylitis.&#x0D; Methods: The clinical trial was conducted at the District Headquarter Hospital, Bahawalnagar, Pakistan, from September to December 2018, and comprised lateral epicondylitis patients having symptoms for &gt;2 weeks. The diagnosis was confirmed on the basis of physical tests and musculoskeletal ultrasound. The subjects were randomly allocated to two equal groups A and B. Group A received deep transverse friction and Mill’s manipulation according to Cyriax approach, while group B received Mulligan mobilisation with movement techniques. Patient-related tennis elbow evaluation index was used to collect data which was analysed using SPSS 20.&#x0D; Results: Of the 60 patients, there were 30(50%) in each of the two groups. The overall mean age was 35.27±7.30 years, and 38(63.3%) participants were male. After 4 weeks of treatment sessions, both groups showed significant improvements (p&lt;0.05) in pain and functional disability scores. Group A showed significantly more improvement (p&lt;0.05) in pain subscale scores compared to group B, while group B showed significant improvement (p&lt;0.05) in functional disability subscale scores compared to group A. There was no significant difference (p&gt;0.05) between the groups on total the patient-related tennis elbow evaluation index score.&#x0D; Conclusion: Both Mulligan mobilisation with movement and Cyriax approach decreased pain and improved functional status in lateral epicondylitis patients.&#x0D; Key Words: Elbow, Lateral epicondylitis, Massage, Mobilisation, Physiotherapy. Continuous..,

The Effect of Adding Kinesio Tape to Mulligan's Mobilization in Patients with A Cervicogenic Headache

Background: Cervicogenic headache is a major problem in many people suffering from upper cervical dysfunction with a great conflict in its physical therapy management. Objective: The aim of the work was to determine the effect of Adding Kinesio Tape To Mulligan's Mobilization in patients with a cervicogenic headache. Patients and methods: Fifty four patients with cervicogenic headache included in the study; from outpatient clinic, Faculty of physical therapy, Cairo University Hospital (Kasr El Ainy), were randomly assigned into two equal groups ; group A (Kinesiotaping and mulligan techniques), Group B (mulligan techniques). Their mean ± SD age, weight, height and BMI were 37.74±5.55 years, 80.62±6.27 kg, 170.11±5.5 cm and 27.48±2.73 kg/m² respectively. The visual analogue scale (VAS) is used for measuring intensity of cervicogenic headache. Frequency and duration of cervicogenic headache are collected from subjective data of patients. Correlations between the examined parameters were also measured. Kinesiotaping application with mulligan SNAGs were companied in group A and mulligan SNAGs done only in group B. Results: There was significant improvement of VAS outcome scores and frequency and duration of cervicogenic headache in Group (A) more than Group (B). Conclusion: It could be concluded that adding kinesio tape to mulligan's mobilization in patients with a cervicogenic headache is found to be an effective in treatment of cervicogenic headache.

The Evaluation of Joint Mobilization Dosage on Ankle Range of Motion in Individuals With Decreased Dorsiflexion and a History of Ankle Sprain.

Mulligan's Mobilization with Movement (MWM) is a common intervention used to address dorsiflexion range of motion (DFROM) impairments. However, the treatment dosage of MWMs varies within the literature. The aim of this study was to examine the effect of serial MWM application on DFROM. Repeated-measures cohort. A Midwestern University and the surrounding community. A total of 18 adults (13 females; age = 29 [12.87]y; DFROM = 30.26° [4.60°]) with decrease dorsiflexion (<40°) participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥18 years old, no lower-extremity injury in the last 6months, and no history of foot/ankle surgery. Participants completed a single data collection session consisting of 10 individual sets of MWMs. DFROM was taken at baseline and immediately after each intervention set (post 1, post 2, … post 10). DFROM was measured with a digital inclinometer on the anterior aspect of the tibia during the weight-bearing lunge test with the knee straight and knee bent. Analysis of variances examined DFROM changes over time. Post hoc analysis evaluated sequential pairwise comparisons and changes from baseline at each time point. Analysis of variance results indicated a significant time main effect for weight-bearing lunge test with knee bent (P < .001) and a nonsignificant effect for weight-bearing lunge test with knee straight (P < .924). Post hoc analysis indicated improvements in the weight-bearing lunge test with knee bent at each timepoint compared with baseline (P < .005). Post 2 improved compared with post 1 (P = .027). No other pairwise sequential comparisons were significant (P > .417). MWMs significantly improved acute knee bent DFROM and indicated that after 2 sets of MWMs, no further DFROM improvements were identified. Future research should investigate the lasting effects of DFROM improvements with variable MWM dosages.

Effects of Mulligan Mobilization and Low-Level Laser Therapy on Physical Disability, Pain, and Range of Motion in Patients with Chronic Low Back Pain: A Pilot Randomized Controlled Trial.

This study aimed to determine the combined treatment effects of Mulligan sustained natural apophyseal glides (SNAGs) and low-level laser therapy (LLLT) on function, pain, and range of motion (ROM) in patients with chronic low back pain. A total of 49 adults participated in this study and were randomly divided into three groups (SNAGs with LLLT group, SNAGs group, and control group). The participants in the SNAGs with LLLT group received SNAGs for 10 min, LLLT for 10 min, and electrotherapy for 10 min. The SNAGs group received SNAGs for 10 min and electrotherapy for 20 min. The control group received electrotherapy for 30 min. All participants received the assigned treatment for 30 min a day, 3 times a week, for 4 weeks. We used the visual analogue scale (VAS) to measure pain, the modified-modified Schober test (MMST) to measure ROM, and the Roland Morris disability questionnaire (RMDQ) to measure physical disability. Compared to the pre-intervention values, the VAS and MMST scores significantly increased after the intervention in the SNAGs with LLLT group (p = 0.000) and the SNAGs group (p = 0.000). The RMDQ score significantly improved in the SNAGs with LLLT (p = 0.000), SNAGs (p = 0.000) and control (p = 0.025) group after the intervention. The inter-group differences were greater for the SNAGs with LLLT and SNAGs groups than for the control group (p = 0.001), and the difference was greater for the SNAGs with LLLT than for the SNAGs (p = 0.001) with respect to the VAS, MMST, and RMDQ scores. These results indicate that significant improvement in pain, function, and ROM may be achieved by a combination of SNAGs and LLLT to treat chronic low back pain.

Effectiveness of Mobilization with Movement in weight bearing position on pain, shoulder range of motion and function in patients with shoulder dysfunction

The purpose of the study was to investigate the effectiveness of mulligan mobilization with movement in weight bearing position on pain, shoulder range of motion and function in patients with shoulder dysfunction. The study was conducted on 32 patients of age between 18-50 years, who are diagnosed with shoulder dysfunction and follow the inclusion and exclusion criteria. Subjects were randomly allocated to two groups. The control group (n=16) received stretching, strengthening and shoulder active range of motion exercises with hot pack. The experimental group (n=16) received the same with an additional mulligan’s mobilization with movement in weight bearing. Clinical outcome measures were pain intensity on numeric pain rating scale, pain free shoulder range of motion in flexion, abduction, internal rotation and external rotation as measured with a goniometer and disability of the shoulder with the help of shoulder pain and disability index. Data was collected at baseline and after 2 weeks of intervention in both groups. The results revealed that there was a statistically significant improvement in pain scores and flexion range of motion of shoulder in the experimental group when compared with control group, however no significant change was observed in disability and other ranges measured.

Short-term Effects of Mulligan's Mobilization With Movement on Pain, Function, and Emotional Aspects in Individuals With Knee Osteoarthritis: A Prospective Case Series

ObjectiveTo evaluate the short-term effects of Mulligan's mobilization with movement (MWM) on pain, physical function, emotional aspects, and proprioceptive acuity after a 2-week treatment period and throughout a 3-week follow-up period. MethodsA single group of 30 participants (60.96 ± 5.16 years) with symptomatic knee osteoarthritis (KOA) was evaluated. The protocol involved 5 evaluations moments, before (baseline) and after 2 weeks of intervention (24 hours after the last session), and at 3-week follow-up. The intervention included 3 Mulligan's MWM techniques. The variables evaluated were pain (pressure pain threshold and Visual Numeric Scale), physical function (range of motion, proprioceptive acuity, and the Western Ontario and McMaster Universities Osteoarthritis Index) and emotional aspects (Beck Depression Inventory). Analysis of variance for repeated measures was used considering a significance level of 5%. ResultsAt the second evaluation (after intervention), the pressure pain threshold presented higher values for rectus femoris, tibialis anterior, and patellar tendon sites and reduced values for the Visual Numeric Scale, Beck Depression Inventory, and Western Ontario and McMaster Universities Osteoarthritis Index compared with baseline. Also, during the follow-up period, all variables returned close to baseline levels. Proprioceptive acuity and range of motion did not present significant changes. ConclusionScores for pain relief, physical function, and emotional aspects improved after a course of MWM in this single group of individuals with KOA. Mobilization with movement had limited outcome during follow-up. It suggests that future clinical trials on the use of MWM for KOA should be considered.

To Study the Effect of Mulligan Mobilization Versus Conventional Therapy in Sacroiliac Joint Pain

Background: Sacroiliac Joint Pain (SIJP) is a pain arising from SIJ structures such as anterior sacroiliac ligament, posterior sacroiliac ligament, interosseous ligaments or articular cartilage. The treatment of sacroiliac joint pain is quite challenging. The standard physical therapy (PT) interventions include repetitive exercises, manual joint mobilization, manipulation, bracing, massage, patient education, aerobic conditioning, general therapeutic exercise and electrotherapeutic modalities. Objectives: To compare the effect of mulligan mobilization versus conventional therapy on pain on VAS, Lumbar Range of motion and functional disability in patients with sacroiliac joint pain. Material and Method: A total 93 patients were screened as per the inclusion and exclusion criteria. Patients were randomly allocated in two groups. Group A received mulligan mobilization and Ultrasound therapy and group B received Conventional therapy i.e Ultrasound therapy. Outcome measures assessed were VAS for pain, Lumbar flexion by modified schober’s test and MODQ for functional Disability. Result: Mean difference of Pain on VAS 4.41±1.04 in group A and in group B 3.63±1.27. Mean difference in Lumbar flexion ROM in group A it was 1.30 ± 0.67 and in group B it was 0.98 ±0.55 Mean difference in MODI Score in group A was 34.67 ± 10.84 and in group B it was 13.50 ± 6.45. Conclusion: In the present study, we found that both the techniques Mulligan mobilization and Conventional therapy are effective in the subjects with Sacroiliac joint pain but Mulligan mobilization was found to be more effective than conventional therapy.

Effect of Mulligan Mobilization in Chronic Non-Spesific Low Back Pain

Effect of Mulligan Mobilization in Chronic Non-Spesific Low Back Pain

Effects of early manual therapy on functional outcomes after volar plating of distal radius fractures: A randomized controlled trial

We sought to investigate the effects of early manual therapy on functional outcomes in patients treated with volar plating of a distal radius fracture (DRF). This was a prospective, single-blinded, randomized controlled trial. Patients treated with volar plating of a DRF were randomly assigned to either Early Manual Therapy Group (EMTG, n=19) or Standard Physiotherapy Group (SPG, n=20). While SPG received standard physiotherapy, EMTG received standard physiotherapy plus Mulligan's Mobilization with Movement technique two sessions a week, through 12 weeks. Function, pain intensity, range of motion, grip strength and the level of disability were assessed using the Patient Rated Wrist Evaluation (PRWE), Visual Analog Scale (VAS), goniometer, hand dynamometer and Disabilities of Arm, Shoulder and Hand (DASH) Questionnaire, respectively. Measurements were made at 3, 6, and 12 weeks postoperatively. Of the 54-screened patients, 39 met the inclusion criteria and were randomized. In total, 32 patients (EMTG, n=15; SPG, n=17) were analyzed. EMTG had significantly better DASH score and wrist flexion at 12 weeks, less pain and better PRWE total score, wrist extension, ulnar/radial deviation, supination and grip strength at all time points. Moreover, wrist flexion increased more with the addition of early manual therapy than standard physiotherapy alone (26.50±13.19 versus 16.21±16.06). The addition of early manual therapy to standard physiotherapy may contribute to better functional outcomes and be more effective in increasing wrist flexion in patients treated with volar plating of a DRF.

The effects of Mulligan's mobilization with movement technique in patients with lateral epicondylitis.

Lateral epicondylitis (LE) is a common problem of the arm. Mulligan has proposed the use of mobilization with movement for LE. To investigate the effects of Mulligan's mobilization with movement (MWM) in LE. Forty patients were included in the study and randomly assigned to group 1 (n= 20), who received MWM, exercise and cold therapy, or group 2 (n= 20), who received exercise and cold therapy. The sessions were conducted five times a week for two weeks. All measures were conducted at baseline, after treatment, at 1st and 3rd months follow-ups. Mann-Whitney U test, a visual analogue scale (VAS) for pain intensity, Patient-rated Tennis Elbow Evaluation (PRTEE) Questionnaire for pain intensity and functional disability and a dynamometer for hand grip strength were applied. VAS activity pain significantly decreased in group 1 after treatment (p= 0.001), at the 1st (p< 0.001) and 3rd months (p= 0.040). There was a significant decrease in VAS night pain in group 1 (p= 0.024), and a significant increase in pain-free grip strength (p= 0.002) after treatment. PRTEE-Pain scores decreased in group 1 after treatment (p< 0.001), 1st (p< 0.001) and 3rd months (p= 0.001). MWM plus exercise and cold therapy is a safe and effective alternative with positive effects on elbow pain, functional capacity, and pain-free, maximum grip strength.

Effectiveness of Mulligans Mobilisation with Movement on Shoulder Dysfunction: A Systematic Review

Introduction: Shoulder dysfunction is common musculoskeletal disorder. This is due to repeated wear and tear of structures around the shoulder joint causing the malpositioning of shoulder. The Mulligan Mobilisation with Movement (MWM) has shown good results in treating the shoulder dysfunction. Aim: To systemically review the available literature of MWM is effective in improving pain, Range Of Motion (ROM) and functioning in patients with shoulder dysfunction. Materials and Methods: Five electronic databases like MEDLINE, PUBMED, Cochrane (CENTRAL), PEDro, and Google Scholar were searched up from March 2019 to September 2019 for randomised control trails of MWM in shoulder dysfunction subjects. The key words used were mobilisation with movement, mulligan’s mobilisation with movement, shoulder dysfunction. Eligibility criteria were Randomised Control Trials (RCT) with 6 out of 12 Cochrane review group for risk of bias assessment published in English language. Results: Nine out of ten studies showed significant changes in mulligan’s MWM group than the general treatment, active ROM exercises, sham’s technique, stretching’s strengthening and stabilisation exercises, end range and mid-range mobilisations, electrotherapeutic modalities and only one showed no significant difference between the two groups but improvements in the pain, ROM, strength and functioning of the subjects with shoulder dysfunction. Conclusion: On overall study of mulligan’s MWM treatment in shoulder dysfunction it has very good improvements on outcome measures such as ROM, pain, strength and functional ability. Further more studies are required for knowing the individual effects of mulligan’s MWM and its short term, long term effects.

Effectiveness of TMJ Mulligan Mobilization in Individuals with Trismus

Objectives: To find out the effect of mulligan mobilization in individuals with trismus. Method: Ethical Clearance was obtained from institutional ethical committee. A total 30 subjects with trismus were selected and mulligan mobilization were given for 1 hour/day and 5days/week. The preassessment of ROM was measured by vernierecaliper and pain was measured on VAS and post interventional assessment was taken for the same after 10 days Result: This study showed significant improvement in the outcome variables concluding that it increases ROM and decreases PAIN. This was confirmed using statistical analysis by using paired t test for within group comparison. ROM Post training there was extremely significant improvement noted with individuals with trismus. p value =<0.0001,VAS post training there was extremely significant improvement noted with trismus p value= <0.0001 Conclusion: Hence Mulligan mobilization is effective in improving ROM and it is also effective in decreasing pain in TRISMUS condition.

Immediate effects of Mulligan's techniques on pain and functional mobility in individuals with knee osteoarthritis: A randomized control trial.

Mulligan's mobilization with movement was shown to be effective when implemented in multimodal therapy for knee osteoarthritis. However, no study has evaluated the Mulligan's technique in isolation and compared the relative effectiveness with sham-controlled interventions. Hence, the present study examined the immediate effects of Mulligan's techniques with sham mobilization on the numerical pain rating scale (NPRS) and timed up and go (TUG) test in individuals with knee osteoarthritis. Thirty participants (mean age: 55.3 ± 8.3 years) with symptoms at the knee and radiographic diagnosis of knee osteoarthritis were randomized into sham (n = 15) and intervention (n = 15) groups. The intervention (I) group received Mulligan's mobilization glides that resulted in relative pain relief for three sets of 10 repetitions. For the sham (S) group, the therapist's hand was placed over the joint surfaces mimicking the pain-relieving glides, without providing the gliding force. The outcome measures NPRS and TUG were recorded by a blinded assessor pre- and post-intervention. Statistically significant differences were identified between the groups in post-intervention median (interquartile range) NPRS (I group: 4.00 [2.00-5.00]; S group: 6.00 [4.00-7.00]) and TUG scores (I group: 10.9 [9.43-10.45]; S group: 13.18 [10.38-16.00]) with the intervention group demonstrating better outcomes (p < .05). Within-group, the post-intervention scores of NPRS and TUG were significantly lower (p < .05) compared to the pre-intervention scores in the intervention group. In the sham group, a statistically significant pre-post change was noticed only in the NPRS scores but not in the TUG scores. Mulligan's techniques were effective in improving pain and functional mobility in individuals with knee osteoarthritis. The underlying mechanisms for observed effects must be examined further, as participants reported pain relief following sham mobilization.

EFFICACY OF MUSCLE ENERGY TECHNIQUES AS AN ADJUNCT WITH MULLIGAN’S MOBILIZATION IN ADHESIVE CAPSULITIS OF SHOULDER

Background: Adhesive Capsulitis most commonly referred to as ”Frozen Shoulder” is an insidious Painful Condition with progressive and gradual restriction of all planes of movement in the glenohumeral joint. Evidence shows Mulligan's mobilization with movement (MWM) mobilization technique is more effective than muscle energy techniques (MET) and conventional therapy in improving shoulder function. Therefore the present study intends to determine the efficacy of muscle energy techniques along with Mulligan’s mobilization with movement, in adhesive capsulitis of theshoulder joint. Methods: The present randomized controlled trial was conducted among 30 subjects including both sex groups aged between 40-60 years diagnosed with adhesive capsulitis of the shoulder. They were randomly assigned into two groups with 15 subjects each. Group A received Mulligan’s mobilization alone, and Group B received Mulligan’s mobilization along with MET. Both the groups received the treatment protocol six times a week for three weeks. Pre and post evaluation of pain was done by using the short-form McGill pain questionnaire, range of motion by the Universal Goniometerand the functional disability by using Shoulder Pain and Disability Index (SPADI). Results: There was a significant improvement (P<0.05) in pre and post-intervention levels in both groups. Between groups analysis, the results are: a range of motion improved 30%, and the values are flexion with a p-value of 0.010, for abduction, internal and external rotations with a p-value of 0.000 except for extension with a p-value of 0.109. On comparison of SPADI using Mann Whitney U test, it showed 50% improvement with a significant difference with a p-value of 0.001 and McGill improved for more than 70% with a p-value of 0.000. Conclusion: Mulligan’s mobilization along with Muscle Energy Technique is found to be more effective in improving quality of life among subjects with adhesive capsulitis of shoulder than Mulligan’s mobilization alone.