Vol. 2, Issue 2, Part A (2025)

Background: Chronic non-specific low back pain (CNSLBP) is a leading cause of disability worldwide and is frequently managed with a combination of exercise and manual therapy. Among lumbar mobilization approaches, Maitland posterior-anterior mobilization and Mulligan Sustained Natural Apophyseal Glides (SNAGs) are widely used, but direct comparative evidence on their relative efficacy remains limited.

Objectives: To compare the effects of Maitland and Mulligan mobilization techniques, each combined with a standardized exercise programme, on pain, disability, lumbar range of motion (ROM) and global perceived effect (GPE) in adults with CNSLBP.

Methods: In this parallel-group randomized controlled trial, 64 adults with CNSLBP (symptoms ≥12 weeks) were randomly allocated to a Maitland group (n = 32) or a Mulligan SNAG group (n = 32). Both groups received 12 treatment sessions over 4 weeks (three sessions/week), comprising the allocated mobilization technique plus an identical exercise programme targeting lumbar and hip flexibility, core stabilization and general conditioning. Primary outcomes were pain intensity (0-10 Numerical Pain Rating Scale) and disability (Oswestry Disability Index). Secondary outcomes included lumbar flexion, extension and side-flexion ROM (dual inclinometer) and GPE (0-10 Likert scale). Outcomes were assessed at baseline, post-treatment (4 weeks) and follow-up (8 weeks). Data were analyzed using intention-to-treat with repeated-measures ANOVA.

Results: Both groups showed significant improvements over time in pain, disability and lumbar ROM (p<0.001). At 8 weeks, the Mulligan group demonstrated greater reductions in pain (mean change −3.9 vs −2.9) and ODI (−18.8 vs −13.3), with moderate between-group effect sizes and significant group × time interactions (p<0.01). Lumbar flexion, extension and side-flexion ROM increased in both groups, with larger gains in the Mulligan group. Mean GPE at 8 weeks was higher in the Mulligan group (7.8±1.4) than in the Maitland group (6.7±1.6). No serious adverse events occurred.

Conclusion: Maitland and Mulligan mobilization techniques, when combined with structured exercise, both yield clinically meaningful improvements in adults with CNSLBP. However, Mulligan SNAGs provide a modest but important advantage in reducing pain and disability and enhancing lumbar ROM and perceived recovery. Where clinician expertise is available, Mulligan mobilization with movement may be considered a preferred manual therapy option within a comprehensive, exercise-based rehabilitation programme for CNSLBP.