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COMPARISON

BETWEEN MULLIGAN
BEND LEG RAISE TECHNIQUE AND
BUTLER NEURAL MOBILIZATION ON PAIN
AND STRAIGHT LEG RAISE IN LOW BACK
PAIN SUBJECTS.

PRESENT BY :
MR. Debanjan
Mondal

Low back pain is Introduction


the most prevalent of all

musculoskeletal
conditions,
afflicting
everyone at some time in their life.
In India incidence of low back pain has been
reported to be 23.09% and has a lifetime
prevalence of 60-85%.
Low back pain is believed to involve 60% to
90% of the adult population at some point in
their life time. It has been reported that 37%
of health care costs associated with low back
pain are a direct result of physical therapy
services.

Brian Mulligan pioneered the techniques of this


concept in New Zealand in the 1970s.
The concept has its foundation built on Kaltenborns
(1989) principles of restoring the accessory
component of physiological joint movement.
Unique to this concept is the mobilization of the
spine whilst the spine is in a weight bearing position
and directing the mobilisation parallel to the spinal
facet planes (Mulligan 1999).
Passive oscillatory mobilisations called NAGs
(natural apophyseal glides) and sustained
mobilisations with active movement SNAGs
(sustained natural apophyseal glides) are the
mainstay of this concepts spinal treatment (Mulligan
1999).
The Mulligan concept of accessory gliding with
active movement can be further expanded in our
clinical practice to justify its place in the assessment

Neurodynamics is an innovative management tools involve


conservative decompression of nerves, various neural
mobilizing techniques and patient education techniques
Neurodynamics offers a fresh understanding and
management strategies for common syndromes such as
plantar fasciitis, tennis elbow, nerve root disorders, carpal
tunnel syndromes and spinal pain.
Neural mobilization is a method of conservative
treatment of disorders of neural tissue.
Appropriate use of neural mobilization procedures
.
depends on excellent knowledge of normal and pathological
anatomy, differences between individual etiological factors,
development of disease and symptom variability

Aim and objective of the study


To study the effect of Mulligan mobilization

(bend leg raise technique) in patient with low


back pain.
To study the effect of Butler Neural
Mobilization in patient with low back pain.
The purpose of this study is to compare the
outcomes between mulligan bent leg raise
(BLR) and butler neural mobilization (NM) in
straight leg raise (SLR)positive and low back
pain (LBP) subjects .

Hypothesis
Null hypothesis (H0 ):

There will be no significant effect on pain and Rom in

subjects treated with mulligan bend leg raise technique


and butler neural mobilization with straight leg raise in
low back pain subjects.

Experimental hypothesis (HA ):

There will be significant effect on pain and Rom in


subjects treated with mulligan bend leg raise technique
and butler neural mobilization with straight leg raise in
low back pain subjects.

ROL (review of literature)


Authors Name Year

Conclusion

Toby Hall

2005

There was a significant increase


in the range by 7 degree in BLR
group.

Toby Hall

2006

These results provide


preliminary for the use of
Mulligans TSLR technique in
the management of LBP

L. Exelby

2002

It can also be incorporated with


functional activities to assist in
correcting joint positional faults
within improved quality
movement patterns.

ROL (review of literature)

Authors Name

Year

Conclusion

David Butler

2005

neurodynamic mobilization
techniques can be effective in
addressing musculoskeletal
presentations of peripheral
neuropathic pain.

John D .Childs

2006

Slump stretching is beneficial for


improving short-term disability,
decreasing pain, and
centralization of symptoms.

Methodology
Study design:

The study design used in this research will be


randomized control trial.
Source of data:
Data will be taken from the the physiotherapy
department of Doon P.G Paramedical college,
dehradun.
Sample size:
The size of the sample will be forty(40).

Study sample:

Both male and female subjects with low back


pain.
Sampling design:
Subjects will be randomly allocated into two
groups i.e. group A and group B
Group A: mulligans bent leg raise (n=20).
Group B: butlers neural mobilization (n=20).

Participants:

Participants with low back ache who will be


referred to physiotherapy department and
willing to take treatment for sessions will be
recruit for study.
Method of data collection:
The method of data collection employed for
the present study will be primary method.

Inclusion criteria:
Unilateral limitation of SLR more than 450.
Age group between 35 -60 years.
Refferd pain distal to buttocks.
No change of pain in lumber flexion and

extension

Exclusion Criteria:
Patient with Red flags for a serious spinal

conditions such as infection, tumors,


osteoporosis, spinal fracture,
Pregnancy
History of spinal surgery
Diminished upper and lower extremity reflexes
Suggestive nerve root involvement
Presence of lower quarter neurological
compromise

Materials:
Materials used for this study consisted of the
following:
Consent Form A signed consent form from
the subjects to allow the subject to be
included in the study.
Record or data collection sheet.

Variables:
Independent variable:
Mulligans bent leg raise technique
Butlers neural mobilization
Dependent variable:
Pain (Visual analog scale)
Range of motion(SLR)

Instrumentation :
Bubble Goniometer- Used to measure Lumbar

movements.

MAIN OUTCOME
MEASURES
Pain intensity:

By Visual analogue scale A scale of 10 cm to


evaluate intensity of pain where 0 represents
no pain and 10 represent unbearable pain.
Range of motion:
Range of motion will be measured by Bubble
Goniometer to measure Lumbar range of
motions.

procedure
All the subjects will be informed in detail about the

type and nature of the study and will be made to sign


the informed consent. Assessment of demographic
data along with initial assessment of visual analogue
scale (VAS), range of motion (ROM) will be measured
pre-treatment and post-treatment of the first session
and last sessions.

GROUP A
Will receive Mulligans Mobilization.
GROUP B
Will receive Butlers Neural Mobilization.

Mulligans bent leg raise technique


Stand at the limited SLR side of the supine patient.
Place his flexed knee over shoulder and ask the

patient to push the knee away with his leg and then
relax, at this point therapist push patients bend knee
up to as far as can in the direction of his shoulder,
on the same side provided there is no pain.
If it is painful alter the direction by taking his leg
more medially or laterally. Sustain this stretch for
5sec and repit it thrice in a session.
With the bend knee over the therapist's shoulder
include a traction with this technique.

Butlers neural
mobilization
1. Patient was instructed to sit erect with knees in

900 of flexion. The presence or absence of symptoms


was recorded.
2. Patients were instructed to slump shoulders and
lower back while maintaining the cervical spine in
neutral. The presence or absence of symptoms was
recorded.
3. While maintaining the position described in step 2
the patients was instructed to touch their chin to the
chest and the clinician applied overpressure into
cervical flexion. The presence or absence of
symptoms was recorded.

4. While maintaining overpressure into cervical flexion the

patient was instructed to extend the knee. The presence or


absence of symptoms was recorded.
5. Position 4 was maintained while the patient was
instructed to actively dorsiflex the ankle. The presence or
absence of symptoms was recorded. This position was held
for 30 sec,a total of 5 repetition.
6. Overpressure of the cervical spine was released and the
patients were instructed to return the neck to a neutral
position. The presence or absence of symptoms was
recorded.
Both technique will be continue twice weekly for 3weeks
total of 6 visit.

Thank
you