Maitland Mobilization vs. McKenzie Press-Up in Chronic LBP

Palestine Ahliya University

Status: Completed

Conditions: Back Pain Lower Back

Treatments: Other: Central Posteroanterior Mobilization; Other: Group B (McKenzie PPU exercise with MFR); Other: McKenzie PPU exercise with MFR

Study type: Interventional

Funder types: Other

Identifiers

NCT07364721

Palestine Ahliya U

Details and patient eligibility

About

ABSTRACT Objective:This study aimed to compare the efficacy of central posteroanterior (PA) Maitland mobilization with myofascial release (MFR) and McKenzie prone press-up (PPU) exercise with MFR in the treatment of adult patients with chronic non-specific low back pain (CNLBP). Materials and Methods:A randomized controlled trial was conducted at Salhab Center and Al Shifa's Specialized Complex in Bethlehem between January 2023 and May 2024. The study included 50 adult patients (aged 18-50) with CNLBP of more than 3 months but less than 2 years' duration, referred by an orthopedic specialist at Beit Sahour Medical Center. Participants were randomly assigned to two groups: one received central PA Maitland mobilization with MFR, and the other received McKenzie PPU exercise with MFR. Pain intensity, functional impairment, and fear-avoidance beliefs were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Fear-Avoidance Beliefs Questionnaire (FABQ). Each patient underwent three sessions per week for four weeks.

Full description

This randomized controlled trial evaluated physiotherapy interventions in adults with chronic non-specific low back pain (CNLBP). The study was conducted at Salhab Center for Physiotherapy and Al Shifa's Specialized Complex in Bethlehem City between December 2023 and May 2024. These centers were selected for their accessibility and coordinated referral system.

Participants were referred from orthopedic assessment to physiotherapy, where baseline evaluations were completed prior to randomization. Random allocation to intervention groups was performed using a concealed allocation method.

Physiotherapy interventions were delivered by licensed physiotherapists according to standardized treatment protocols to ensure consistency. Treatment sessions consisted of structured therapeutic exercises and manual therapy techniques, with progression individualized based on patient response. Outcome data were collected at baseline and at the end of the intervention period using validated assessment tools. Participant adherence and adverse events were monitored throughout the study. All procedures were conducted in accordance with ethical standards, and informed consent was obtained from all participants.

Enrollment: 50 patients

Sex: All

Ages: 18 to 50 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 and 50 years of age,
• Male or female, with NSLBP localized between the lower rib and the gluteal fold
• Persisting for more than three months and occurring on at least half of the days in the past three months, with pain affecting daily functional activities.
• VAS score between 40 mm and 80 mm at the initial assessment
• No use of NSAID medications during treatment sessions.

Exclusion criteria

• Patients younger than 18 or older than 50 years,
• Those with mental health disorders, systemic or neurological diseases, or specific spinal pathologies such as facet joint dysfunction, piriformis syndrome, disc herniation, spinal tumors, spondylitis, spondylolisthesis, spinal stenosis, or spinal osteoporosis. Patients were also excluded if they had contraindications to mobilization, a history of spinal surgery or epidural injections, physiotherapy for LBP within the last six months, a VAS score outside the 40-80 mm range, pregnancy, or a current upper limb injury.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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50 participants in 2 patient groups

Arm 1- Group A :Central PA Maitland mobilization with MFR

Experimental group

Description:

Central PA Maitland mobilization with MFR

Treatment:

Other: McKenzie PPU exercise with MFR

Other: Group B (McKenzie PPU exercise with MFR)

Arm 2- Group B:McKenzie PPU exercise with MFR

Experimental group

Description:

Patient position: The patient assumes a prone position. investigator position: The investigator stands beside the patient and provides verbal instruction. Direction: Patients were being instructed to perform PPU exercise by using their upper limbs to push their upper body up into spinal extension while the pelvis remained on the treatment table. The patient is trained to extend the lumbar spine to the maximum pain-free range. Frequency: Ten repetitions for three sets with a 30-second break between each set for almost 10 minutes \[27\].

Treatment:

Other: Group B (McKenzie PPU exercise with MFR)

Other: Central Posteroanterior Mobilization