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

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

2. Introduction
 Low back pain is 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.

3. Brian Mulligan pioneered the techniques of this concept in
New Zealand in the 1970s.
The concept has its foundation built on Kaltenborn’s (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 concept’s 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 of muscle dysfunction.

4. 

 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
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.
.

5.  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 .
Aim and objective of the study

6. 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.

7. ROL (review of literature)
Author’s 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 Mulligan’s 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.

8. ROL (review of literature)
Author’s 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.

9. 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).

10.  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: mulligan’s bent leg raise (n=20).
 Group B: butler’s neural mobilization (n=20).

11.  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.

12. 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

13. 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

14. 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.

15. Variables:
Independent variable:
 Mulligan’s bent leg raise technique
 Butler’s neural mobilization
Dependent variable:
 Pain (Visual analog scale)
 Range of motion(SLR)

16. Instrumentation :
 Bubble Goniometer- Used to measure Lumbar
movements.

17. 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.

18. 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 Mulligan’s Mobilization.
GROUP B –
 Will receive Butler’s Neural Mobilization.

19. Mulligan’s 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.

20. Butler’s 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.

21.  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.

22. PROTOCOL
Subjects meeting the inclusion criteria
Subjects included in the study (n=40)
Subjects randomly assigned into two group
Number of subjects
randomly assigned
for mulligan’s bent
leg raise technique
(n=20)
Number of subjects
randomly assigned
for butler’s neural
mobilisation (n=20)
Received allocated
treatment (n=20)
Received allocated
treatment (n=20)
Data collected Data collected
Interpreted Interpreted

23. `