DOI Number: 10.5958/j.0973-5674.7.3.

088
Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3 177

Effect of Maitland Spinal Mobilization Therapy Versus

Conventional Therapy in Lumbar Spondylosis with
Radiculopathy
Priya Igatpurikar
Lecturer - N.D.M.V.P'S college of Physiotherapy, Nashik, Maharashtra
ABSTRACT
Objectives: To compare SMT with conventional therapy in lumbar spondylosis with radiculopathy.
Design : Randomized controlled trial.
Material : Inch tape, pen , goniometer, SWD , lumbar traction unit , Hot packs.
Method: A RCT was done and patients with lumbar spondylosis were allocated in two group.
Gr. I received Maitland's mobilization in P-A , rotational and transverse mobilization with hot
packs and core stabilization. Gr. 2 received lumbar traction, Shortwave diathermy and core
stabilization.
Each group had 20 patients and they were evaluated on day one pre treatment and day 30 post
treatment. Outcome measures used for assessment were pain on VAS scale, spinal ROM by Schober's
test SLR and Oswestry Disability Scale for functional evaluation.
Results: Spinal mobilization and conventional therapy both showed improvement in pain and spinal
ROM but spinal mobilization however mobilization therapy showed significant improvement than
conventional group (t value = 2.149, p < 0.05). SLR & ODI showed improvement within group but
not between the two groups.
Conclusion : Spinal mobilization is better than routine conventional therapy .
Keywords: Lumbar Spondylosis, Maitland spinal Mobilization, PA glide, Transverse glide, Rotational
mobilization, SWD

INTRODUCTION
The loss of youth is melancholy enough : but to
enough into through the gate of infirmity, most
dishearting16
Horace Walpole, 1765
Although backache with or without sciatica is a
benign, often self-limiting condition, it drains upto $
60 billion dollars per year from American
Governments health care budget.16,11

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177

Out of various conditions affecting low back,

degeneration of spine is the most common cause.
Spondylosis affects intervertebral disc, facet joints,
bones and ligament. Unfortunately as we age, our
intervertebral disc lose their flexibility , elasticity and
shock absorbing characteristics. 6,10 The annulus
fibrosis become brittle & nucleus pulposus begin to
dessicate. The combination of damage to intervertebral
disc, development of bony spurs, and gradual
thickening of ligaments that support the spine can all

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178 Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3

contribute to degenerative arthritis of lumbar spine.

This can cause several symptoms including back pain,
leg pain and weakness due to compression of nerve
roots.11
There are few studies done by Sims Williams et al
(1978,79) Rasmussen (1979) , Bergquist Ullman
(1977), Christman et al (1964) , Doran and Newel
(1975), Coxhiah et al (1981) as well as Farrell and
Towmey (1982) documented that SMT is superior than
any other conventional therapies. Dr.P.Senthil Kumar,
Dr. Preeth John Cherian, MAHE, has done studies on
Maitlands mobilization versus conventional therapy
in treatment of lumbar disc herniation and showed that
Maitlands mobilization had significant results as
compared to conventional therapy . Thus this study
was taken to update the effectiveness of Maitland
spinal mobilization in degenerative spines in Indian
populations.

Blood coagulation disorders.

Severe osteoporosis.
Sacroiliac diseases.
1. Method of Collection of Data: Randomized
controlled trial.
2. Sample Size: Total patients :- 40
Group A: 20 patients receiving Maitland
Mobilization Therapy, hot packs and core
stabilization.
Group B: 20 Patients receiving conventional
therapy (traction and SWD) and core stabilization.
3. Materials or Equipment Used :

Inch tape

Traction table

SWD

Hot packs

MATERIAL AND METHODOLOGY

1. Selection of Cases
Kamala Nehru Hospital and Sancheti Hospitals
P.T.O.P.D.

4. Outcome Measures

2. Age Group: 45 to 60 years.

VAS for pain

3. Inclusion Criteria: Patients diagnosed as having

lumbar spondylosis with radiculopathy.

ROM

SLR

Oswestry Disability Index

Both sexes included.

VAS 6 to 10
4. Exclusion Criteria:
spondylolisthesis.

spondylolysis

Spinal tumors.
Infective spinal condition.
Severe canal stenosis.
Ankylosing spondylosis.
Spinal fractures.

Patients included in this study were known case

of lumbar spondylosis with radiculopathy. Consent
was taken and patients were randomly allocated
for treatment.
Group 1: Received Maitland spinal mobilization
(grade 1 to 4) Hot packs and core stabilization.
Group 2: SWD, Intermittent lumbar traction & core
stabilization.

Spinal surgeries.
Pregnancies.
Severe sensory or motor weakness.
Disease of spinal cord and cauda equine.
Scoliosis.

35. priya igatpurikar--177--183.pmd

PROCEDURE

and

178

Pain on VAS , number of past and present

complaints was taken. Spinal ROM was assessed
by Modified Schober Test and side flexion and
rotations was assessed by tape method . MMT
was done according to Kendall method for
abdominals , back extensors and lower limb
muscles. Sensory evaluation, reflex testing and
special tests such as neural tissue tension test
and sacroiliac joint test was also done.

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Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3 179

Group A : This consists of experimental group

in which subjects were given hot packs for
relaxation prior to mobilization therapy.
Maitlands gr1 to gr.4 central , unilateral ,
transverse ,rotational mobilization was given to
the affected vertebra and one vertebra above
and one vertebra below.
1. The amplitude used initially was Gr. I and II for
pain relief & grade III and IV was used to
improve ROM, slow speed, smooth rhythm & 2
to 3 oscillations /sec for 30 sec. 2 to 3 sets for each
vertebra.
2. Mobilization was followed by core stabilization
exercises .
3. Patients were treated for 4 weeks and
assessment and outcome measures were taken
on 1st and 30th day .
Group B: the other group received intermittent
lumbar traction , Short wave diathermy and core
stabilization and flexibility exercises .
ILT parameters: As per the study done by Lee and
Evans

Patient was taken in supine with hip-knee in 90-90

and leg supported on stool with pillows. Angle of pull
was adjusted between 18 to 34 degrees & weight
applied was slightly less than 50 % of body weight
Hold and relax time: 15/15 min. duration of treatment:
15 min.
SWD : Patient was taken in supine with hip- knee
flexed position and coplanar method of application
was used.
Statistical Analysis
Data Collection: The study was conducted
between May 2005 to 15 October .2006.
Statistical Analysis: A pairedt test was done to
analyze the results within group for pain in VAS, spinal
ROM and SLR.
Unpaired t test was done to analyse the results
between the two groups for VAS, spinal ROM and
SLR. The p level was set to 0.05.
Oswestry disability index results were analyzed
by Mann-Whitney test.

Table 1. Demographic Data

Patient Characteristics
Sr No

Variables

Experimental Grouop
(N = 20)

Mean Age

Male / Female

Control Group
(N = 20)

50.75

50.35

6 M / 14 F

7 M / 13 F

Mean Duration Of Symptoms (Months)

1.45

1.3

Number Of Patients With Past Episodes

13

Occupation Distribution
Light Work

12

10

Moderate Work

Heavy Work

Table 2. Vas Score

Experimental
Pre mean_+ S.d.

Control

Unpaired
T Test

Post mean _+ S.d.

Paired T Test

Pre mean_+Sd

Post mean_+Sd

Paired T Test

1.45_+0.51

24.375*

7.5_+0.688

2.05_+0.68

32.1056*

7.55_+0.88

2.1495*

* Indicates P < 0.05 (Significant Difference)

Table 3. SLR
Experimental
Premean_+ S.d.
51_+ 5.98

Control

Postmean _+ S.d.

T Value

Premean_+Sd

Postmean_+Sd

T Value

94.5_+ 5.1

33.1*

51_+ 5.938

91_+ 5.53

22.6*

* Indicates P < 0.05 (Significant Difference)

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179

Unpaired
T Test

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1.703

180 Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3
Table 4. Spinal Rom
Movement

Group

Mean Rom

S.d.

Exp

4.55

0.944

21.54*

Cont

3.275

0.525

22.6*

Exp

1.75

0.5

15.62*

Flexion
Extension
Rt. Side Flexion
Lt. Side Flexion
Rt. Rotation
Lt. Rotation

Unpaired T Test

Cont

1.85

0.609

12.6*

Exp

3.75

0.786

21.35*

Cont

3.15

0.75

18.9*

Exp

3.75

1.164

14.36*

Cont

2.65

1.03

11.39*

Exp.

0.975

0.8

5.44*

Cont.

1.45

0.551

11.58*

Exp.

1.25

0.769

6.46*

Cont.

1.45

0.483

13.39

5.276*
0.567
2.171*
0.9839
2.476*
3.1513*

* Indicates P < 0.05 (Significant Difference)

Table 5. Oswestry Disability Index

Experimental
Grade

Control

Pre

Post

Pre

Post

Minimum

Moderate

20

20

Severe

11

14

Crippled

Bed Bound

Experimental

Control

U Value

36.2

30.5

145

10.758

5.226

Oswestry Disability ( Mean Sd) And U Value :-

Mean
Sd
Critical U Value 127, Results Higher Than 127 Indicate Insignificant Values.

Fig. 1. Rotational mobilization

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180

Fig. 2. Transverse glide

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Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3 181

diminished when there is pain or stiffness in a

lumbar segment. Neurological deficits associated with
radicular pain are thought to arise from mechanical
compromise , ischemia , or inflammation of spinal
and dorsal root ganglia complex (Hause 1993)
possibly associated with intervertebral disc lesion or
osteophytic encroachment.

Fig. 3. Central P-A glide

Fig. 4. Unilateral P-A glide

DISCUSSION
Low back pain is the most common ailment and
every one in life experiences it due to one or the other
reason. Out of the various reasons lumbar spondylosis
is the third leading cause of disability in people above
45 years. 12
The rational for using Spinal manipulative
therapy in the hypomobile joint in lumbar spondylosis
is that these joints place excessive stress or strain
on neighboring joint and may if long standing
promote hypermobility in neighboring joints similar
to translational hypermobility.13, 14 ,16
Janda noted that altered joint function affects the
quality of muscle function across the involved joint
. Jull and Janda stated that the proprioceptive
input required for good motor control may be

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181

Pain showed improvement in both the groups i.e

(P<0.05) There was however more improvement in
the experimental group than the control group. This
could be attributed to the stimulation of
mechanoreceptors in the joint capsule , ligament, disc
etc there by causing stimulation of large diameter
that block the transmission of nociceptive impulses
(Paris 1979 , Wyke 1985) Thus closing the gate of pain
(Melzack and Wall ) The other mechanism of
relief of pain is by reducing the swelling containing
neurotransmitter such as substance P , histamine
and gentle oscillations may also raise the threshold
of nociceptors (Zusman 1986)
Similarly radicular pain reduction in control group
is attributed to the mechanical effects of ILT and
thermal effects of SWD . Since SWD causes deep
heating , increased circulation and extensibility of
collagen and induces relaxation and reduces muscle
spasm. Traction separation of vertebra thus
increases diameter of vertebral foramen and is
responsible for reduction of pain and normalize
neurological deficits by directing relieving pressure
(Colachis and Stroem 1969, Twomey 1985) It is also
said to reduce disc protrusion and stimulate
mechanoreceptors by intermittent movement. (Martin
Krause 2000)
Core stabilization also plays important role in
reducing pain and it was given to both the groups.
Core exercises helps motor control training & patient
learns to activate his natural lumbar corset of body
and stabilize the spine during various activities. When
deep segmental muscles are activated , there is
improved motor control, endurance, and thus less fear
of re-injury.
There was statistically significant improvement in
SLR in both the groups. (Exp t- 33.13 and control t25.29) but no significance was found between the
two groups.

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182 Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3

When spinal movements are considered , both the

groups showed improvement in ROM. (P<0.05)
Oswestry Disability Index did not show statistical
significance ,(U=145) but there was clinical
improvement in both the group.
Thus
after analyzing the results , it can be concluded
that , both spinal mobilization therapy and
conventional therapy had significant improvement
but spinal mobilization therapy showed better
outcome than conventional group in pain reduction
& improving ROM where as no much difference in
SLR and disability index. Since the patients had
improvement in few functions , the study should be
carried out for a longer time to have a better outlook
on the effect of mobilization therapy in functional
improvement of the patients. Thus although evidence
is lacking for manual therapy as a sole intervention, it
can be used with other therapies such as exercises,
cortico-steriods and physical therapy in routine
clinical practice to have better and cost effective
outcomes.

5.

6.

7.

8.

9.

10.

CONCLUSION
From this study it is concluded that
11.
Spinal mobilization therapy and conventional
group showed improvement in pain , SLR , spinal
ROM and functions. (p<0.05) However experimental
group showed little more statistical significant than
control group. (t-2.149 ,p<0.05).
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