Mulligan Mobilization Techniques for Non-Specific Low Back Pain

Low back pain is the second most common cause of disability worldwide and significantly affects quality of life and healthcare systems. Non-specific low back pain (NSLBP) accounts for nearly 85% of all low back pain cases and is associated with loss of function, reduced productivity, and psychological problems. Physiotherapy approaches such as exercise, manual therapy, electrotherapy, and patient education are widely used, but not all patients benefit equally, highlighting the need for innovative and individualized treatment strategies. Mulligan mobilization is a manual therapy method that combines physiological joint movements with pain-free mobilization techniques. Techniques such as hip mobilization and traction-assisted straight leg raise (SLR) are thought to improve pain, range of motion, and functional outcomes. Although some studies suggest positive effects of Mulligan techniques, there is a lack of randomized controlled trials directly comparing different Mulligan approaches in patients with NSLBP. This triple-blind randomized controlled trial will investigate the comparative effectiveness of two Mulligan mobilization techniques. Thirty adults with NSLBP will be randomly assigned into three groups: (1) conventional physiotherapy plus hip internal rotation Mulligan mobilization, (2) conventional physiotherapy plus SLR Mulligan mobilization, and (3) conventional physiotherapy only. Interventions will be delivered twice a week for four weeks by experienced physiotherapists certified in the Mulligan Concept®. The primary outcomes will be pain intensity measured with the Visual Analog Scale (VAS) and lumbar range of motion assessed by goniometer. Secondary outcomes include disability level measured with the Oswestry Disability Index (ODI) and back awareness assessed with the Fremantle Back Awareness Questionnaire (FreBAQ). The findings of this study are expected to provide evidence on whether Mulligan mobilization techniques offer additional benefits beyond conventional physiotherapy in the management of non-specific low back pain.

Inclusion criteria

• Age ≥ 18 years
• Diagnosed with non-specific low back pain (NSLBP) for at least 3 months
• Able to walk independently
• Willing to participate and provide written informed consent

Exclusion criteria

• Specific causes of low back pain (e.g., disc herniation, spinal stenosis, tumor)
• Presence of neurological deficits or radiculopathy
• Hip joint pathologies limiting mobility (e.g., osteoarthritis)
• History of lumbar surgery in the last 6 months
• Diagnosed osteoporosis or osteopenia
• Contraindications for Mulligan mobilization
• Severe physical or cognitive impairments preventing participation
• Participation in other physiotherapy or manual therapy treatments during the study period