Immediate, short and long-term clinical results of combined Mulligan mobilization with movement techniques in non-specific chronic low back pain: a randomized placebo-controlled trial

Introduction
Although the effectiveness of many mobilization methods in chronic low back pain (CLBP) was shown, these effects were not monitored in the long term. This study aimed to identify the immediate, short, and long-term effects of mulligan mobilization with movement (MWM) in CLBP.

Material and methods
The study was designed in randomized-placebo controlled with 36 patients. Pain, range of motion (ROM), flexibility, endurance, functionality, and disabilities were evaluated in both groups. Sustained natural apophyseal glide (SNAG) was applied to the lumbar region, straight leg raise (SLR) with traction to the hip, and internal rotational mobilization techniques and home exercise program were applied in Group 1 (n=19); and the same techniques were applied as sham mobilization in Group 2 (n=17), for 5 weeks for both. The evaluations were made post-intervention, at the 5th week, 3rd month, and 6th months. The evaluation was also made for pain in the 12th month.

Results
Significant differences were observed between the groups at the end of the treatment, except for The Biering- Sorensen test (SOR) and Sit and Reach Test (SRT) (p<0.05). Although Real MWM showed its immediate effects on pain, internal rotation, and hip flexion ROMs (p<0.05); its effect on flexibility, disability, functionality, endurance, and lumbar flexion ROM, SLR ROM were seen in the long term (p<0.0001). These effects continued for flexibility, disability, functionality and endurance until the 6th month.

Conclusions
The long-term benefits of the MWM Technique, applied to the lumbar region including the hip techniques and its superiority to Sham MWM are the results of this study.