• Physical Therapy Rehabilitation Science
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• v.10 no.4
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• pp.450-456
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• 2021

Objective: Studies confirming the lumber spine kinematics of direct or indirect segmental mobility under the application of joint mobilization, which induces passive force on the spine, are insufficient.Therefore, this study aims to obtain the underlying clinical data by identifying direct or indirect segmental mobility produced by Maitland's PA mobilization technique. Design: Randomized controlled trial design. Methods: Thirty subjects with no back pain participated in this study. X-ray testing equipment (SIG-40-525, Ecoray Inc., Korea) was used to verify the segmented movement of their lumbar. Joint mobilization was performed by physiotherapists with more than 10 years of experience in prescription therapy, and radiography was performed once without PA joint mobilization and once without the mobilization for comparing the lumbar vertebrae before and after the mobilization. The radiographs taken were analyzed using the picture archiving and communication system (PACS) program to measure the spinal displacement, intervertebral height, intervertebral angle, and lumbar lordosis angle. Results: Significant differences were observed in the lumbar displacement, intervertebral angle, and lumbar lordosis angle in all lumbar vertebrae before and after the mobilization. The intervertebral height indicated significant differences in all ventral vertebrae and only in L3-L4 and L4-L5 in dorsal vertebrae. Conclusions: This study suggests that the segmental mobility produced through indirect approaches plays an important role in inducing therapeutic effects in patients with back pain.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.13 no.2
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• pp.21-30
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• 2007

Purpose: The purpose of this study was to evaluate effects of lumbar vertebrae mobilization and lumbar stabilizing exercises on the muscle strength. Methods: The subject were sixty healthy adult(30 females. 30 males) two decade from 21 to 35. All subjects randomly assigned the control group, lumbar vertebrae mobilization group, lumbar stabilizing exercises group. lumbar stabilizing exercises group received lumbar stabilizing exercises for 30 minutes, lumbar vertbrae mobilization group received lumbar vertbrae mobilization for 4-5 minutes per day and three times a week during 3 weeks period. BIODEX was used to measure muscle strength. All measurements of each subjects were measured at pre-experiment, after 10 day, and post-experiment. Results: The results of this study were summarized as follows; 1. The flexion strength test of control group, lumbar vertebrae mobilization group, lumbar stabilizing exercises group were no significantly differences at pre-experiment and after 10 days(p> .05), however significantly increased post-experiment(p <.05). The result of analyzed effects of flexion strength test was significantly increased accordining to experiment type(p <.05). 2. The extension strength test of control group, lumbar vertebrae mobilization group, lumbar stabilizing exercises group were no significantly differences at pre-experiment and after 10 days(p> .05), however significantly increased post-experiment(p <.05). The result of analyzed effects of extension strength test was significantly increased accordining to experiment type(p <.05). Conclusion: conclusionally these data suggest that a 3-week lumbar stabilizing exercises improved muscle strength. Additional randomized controlled trials to more fully investigate trement effects and factors that may mediate these effect are needed.

• Physical Therapy Rehabilitation Science
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• v.12 no.3
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• pp.240-250
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• 2023

Objective: The purpose of this study was to characterize the movement of adjacent segments that occurred when posteroanterior joint mobilization was applied to the 3rd lumbar and thereby to provide basic clinical data. Design: Randomized controlled trial design. Methods: While the subjects were receiving posteroanterior joint mobilization of the 3rd lumbar vertebra, LD (lumbar displacement), LID (lumbar intervertebral distance), LIA (lumbar intervertebral angle), and LLA (lumbar lordosis angle) were measured using X-ray, and the data were then analyzed. Changes before and after posteroanterior joint mobilization were analyzed using a paired-sample t-test, and a one-way ANOVA of variance was performed to determine the difference between segmental movements. In addition, Pearson's correlation analysis was performed to determine the correlation between segmental movements. Results: The results revealed that there was a significant change in LD before and after the application of joint mobilization of the 3rd lumbar in all lumbar vertebrae (p<0.000), among which the 2nd lumbar vertebra, an adjacent segment, showed the most significant change. A significant change in LIA angle was observed in all segments (p<0.000), with the most significant change observed between the 2nd and 3rd lumbar vertebrae. There was a significant change in LLA before and after the application of posteroanterior joint mobilization (p<0.000). The correlation analysis showed a high correlation between displacement of the 3rd lumbar vertebra and displacement of all the other lumbar vertebrae. Conclusions: The presence of kinematic movements of the lumbar vertebrae when segmental movements were generated through the application of posteroanterior joint mobilization of the 3rd lumbar vertebra.

• Journal of International Academy of Physical Therapy Research
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• v.12 no.1
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• pp.2302-2307
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• 2021

Background: Patients with lumbar spinal stenosis show abnormal changes in muscle activity due to pain and limited range of motion of the lumbar spine. Excessive increased muscle tone and decreased muscle activity patterns threaten the patients' quality of life. However, there have been a few studies showing how to improve muscle performance in patients with lumbar spinal stenosis. Among these, joint mobilization is one way of improving muscle performance through pain relief and increasing the range of motion. Objectives: To investigate the effect of lumbar mobilization by orthopedic manual physical therapy on paravertebral muscle activity and tone in patients with lumbar spinal stenosis. Design: A randomized controlled trial. Methods: In this study, 24 patients with lumbar spinal stenosis were randomized (1:1 ratio) into two groups. The experimental group underwent lumbar posteroanterior mobilization, and the control group underwent conventional physical therapy (conventional transcutaneous electrical nerve stimulation) for 15 minutes each. For outcome measures, Myoton^®PRO was used to evaluate muscle tone when resting of the paravertebral muscle in the pain area. For muscle activity evaluation, the reference voluntary contraction of the paravertebral muscle was evaluated using surface electromyography. Results: Muscle tone and activity were significantly improved after intervention in both the experimental and control groups. In addition, the experimental group showed more significant decrease in muscle tone and activity than the control group. Conclusion: These results suggest that lumbar mobilization improving muscle performance in patients with lumbar spinal stenosis.

• Journal of International Academy of Physical Therapy Research
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• v.9 no.4
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• pp.1676-1682
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• 2018

The purpose of this study was to investigate the short-term effects of lumbar rotational mobilization under the single-leg standing (SLS) position. Fifteen healthy individuals were recruited, and randomized to agroup of trunk rotational exercise (TRE) and lumbar rotational mobilization (LRM). Trunk twist rotational exercise was performed to the TRE group, and mobilization was applied to the LRM group on the lumbar spine. Velocity of the center of pressure (VCOP) and center of pressure (COP) for each participant were measured through SLS. COPs were not significantly increased or decreased after treatment in both groups. VCOPs also did not change considerably except on the right side when the eye was closed. There was no significant difference between COPs and VCOPs in two groups. This study suggests that trunk rotation exercise and lumbar rotation mobilization would have similar effects on balance ability.

• Journal of International Academy of Physical Therapy Research
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• v.10 no.1
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• pp.1711-1716
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• 2019

Background: Previous researchers have investigated the mechanical and neurophysiological effects of manual mobilization, however little research has been done on muscle tone and muscle stiffness. Objective: To compare the effects of posterior-anterior (PA) mobilization with weight bearing on sling and conventional PA mobilization on the bed. Design: Randomized controlled trial (single blind) Methods: The subjects were 16 male university students and randomized to sling mobilization group (SMG, n=8) or conventional mobilization group (CMG, n=8). SMG received PA mobilization using a sling and CMG received traditional mobilization on the bed during lumbar mobilization. Results: Both left and right muscle tones of SMG increased, but left muscle tone of SMG were increased and right muscle tone was decreased after intervention. In addition, both left and right muscle stiffness of SMG were also increased, however left muscle stiffness of SMG was increased and right muscle stiffness was decreased. The muscle tone and muscle stiffness of SMG were higher than those of DMG, especially the right side was statistically significantly higher. Extension of SMG, extension and flexion of CMG were increased statistically significantly except for Flexion of SMG (p<.05). There were no significant differences between the groups in Extension and Flexion. Conclusions: This study suggests that lumbar spine PA mobilization using sling is beneficial in improving muscle tone, muscle stiffness, and trunk movement.

• Journal of International Academy of Physical Therapy Research
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• v.11 no.2
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• pp.2090-2095
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• 2020

Background: Spinal Mobilization is one of the manual therapy technique that clinicians have used to treat pain, however, there is still a lack of research on changes in strength in healthy people. Objectives: To investigate the effect of posterior-anterior lumbar mobilization on lower limb strength in healthy individuals. Design: Two-group pretest-posttest design. Methods: In this study, 23 healthy subjects aged 20 years were assigned to 12 lumbar mobilization group (LMG) and 12 sham group (SG) to perform intervention and measurement through pre- and post-design. Intervention was performed in LMG with grade III~IV on L3-5 of the lumbar spine, and lumbar mobilization was performed for each segment. After intervention, knee flexion and extension strength were measured. To measure the main effect on muscle strength, a comparative analysis was conducted using paired t-test and independent t-test. Results: In LMG, knee flexor and extensor strength were increased significantly at 60°/s (P<.05). In addition, the extensors of LMG and SG were significantly different only at 60°/s, and the flexors were significantly different between groups at both 60°/s and 180°/s (P<.05). Conclusion: In healthy individuals, lumbar mobilization results in improvement of strength of knee flexor and extensor, and additional experiments on the effect of mobilization on the lumbar spine on functional changes in the lower limbs will be needed.

• Physical Therapy Korea
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• v.22 no.3
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• pp.1-11
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• 2015

The purpose of this study was to investigate the effect of lumbar stabilization training and additional thoracic mobilization on pain, proprioception and static balance in patients with chronic low back pain. The subjects of this study were 48 chronic low back pain patients who were randomly allocated to an experimental group 1 ($n_1=16$, lumbar stabilization and thoracic mobilization, thoracic hypomobility), experimental group 2 ($n_2=16$, lumbar stabilization and thoracic mobilization, thoracic normal mobility), and a control group ($n_3=16$, lumbar stabilization, thoracic hypomobility) after a thoracic mobility test. Both experimental groups underwent lumbar stabilization training and additional thoracic mobilization. The control group underwent only lumbar stabilization training. The intervention was performed 3 times per week, 30 minutes each time, for a total of 6 weeks. Thoraco-lumbar joint reposition error was measured using an electrogoniometer and static balance ability was measured using the Tetrax posture analysis system. Subjects' pain level was measured using a 100 mm visual analogue scale. Statistical analyses were performed using a one-way analysis of variance and a paired t-test. Post-hoc testing was carried out with a Bonferroni test. The pain level was significantly lower in both experimental groups compared to the control group. Both experimental groups showed significant reductions in joint reposition error angle (flexion, extension, and side bending) compared to the control group. The static balance level was significantly lower in both experimental groups than in the control group. In summary, lumbar stabilization exercises and additional thoracic mobilization significantly improved the pain level, proprioception, and static balance in patients with chronic low back pain.

• Journal of the Korean Society of Physical Medicine
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• v.2 no.2
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• pp.113-124
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• 2007

Purpose : The purpose of this study was to investigate the effects of joint mobilization on the rang of motion and pain of patient with chronic low back pain. Methods : The subjects were consisted of thirty patients with chronic low back pain(19 females, 11 males ; mean aged 59.93) from 50 to 71. All subjects randomly assigned to the modalities treatment group, joint mobilization group. Modalities treatment group received hot pack used thermal therapy for 20minutes and ICT used electrical therapy for 15minutes, joint mobilization group received modalities treatment with sustained natural apophyseal glides(SNAGS) techniques of Mulligan for 10minutes per day and three times a week during 2 weeks period. Visual Analogue Scale(VAS) was used to measure subjective pain level. Remodified Schober test(RST) was used to measure range of motion of lumbar spine. All measurements of each patients were measured at pre-treatment and 2 weeks post-treatment. Results : The results of this study were summarized as follows : 1. VAS was joint mobilization group showed significantly decreased more than modalities treatment group (p<.05). 2. The lumbar flexion range of motion was joint mobilization group showed significantly decreased more than modalities treatment group(p<.05). 3. The lumbar extension range of motion was joint mobilization group showed significantly decreased more than modalities treatment group(p<.05). 4. The lumbar left lateral flexion range of motion was joint mobilization group showed significantly decreased more than modalities treatment group(p<.05). 5. The lumbar right lateral flexion range of motion was joint mobilization group showed significantly decreased more than modalities treatment group(p<.05). Conclusion : These data suggests that SNAGS of Mulligan is beneficial treatment for chronic low back pain.

• Journal of International Academy of Physical Therapy Research
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• v.10 no.1
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• pp.1746-1749
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• 2019

Background: Surgery has been known as an inefficient approach to reduce back pain in patients with lumbar spinal stenosis; therefore, non-surgical treatments are necessary. However, there has been little research to analyze the effect of non-surgical treatments on lumbar spinal stenosis pain. Objective: To identify the effectiveness of 2 physiotherapeutic treatment approaches to relieve pain due to lumbar spinal stenosis. Design: Randomized controlled trial Methods: The participants were 36 lumbar spinal stenosis patients who were randomized in the joint mobilization group (JMG) and transcutaneous electrical nerve stimulation group (TENSG). Joint mobilization (JM) was conducted at the posteroanterior joint in the spinous process of the lumbar spine with stenosis. Transcutaneous electrical nerve stimulation (TENS) was applied on the lumbar spine with stenosis at a high frequency and intensity. Results: Visual analog scale (VAS) pain score significantly decreased in both groups, and the VAS value decreased more after JMG than that after TENSG. The pain thresholds of both groups also significantly increased, and that of JMG increased more compared to TENSG. In both the groups, significant improvements in VAS and pain thresholds were found, and JMG showed better results than TENSG. Conclusions: JM and TENS showed significant relief in both pain threshold and painpain, and JM showed more advanced relief compared to TENS.