Mulligan mobilization versus traction in lumbar facet joint syndrome: randomized controlled trial


  • Mohammed Hussien Elgendy
  • Ahmed Abduallah Habib
  • Ramy Edward Ibrahim
  • Yasser Ramzy Lasheen
Palabras clave: Mulligan mobilization, Lumbar traction, Facet joint syndrome


The aim of this study was to investigate and compare the effect of Mulligan mobilization, lumbar traction and their combination on pain, functional disability and facet tropism in patients with facet joint syndrome. Sixty patients with facet joint syndrome from both sexes and aged 30 to 50 years participated in the randomized controlled trial design. They were referred from orthopedic and neurological clinics and divided into four groups as follows: group A received Mulligan mobilization and conventional treatment, group B received lumbar traction and conventional treatment, group C received Mulligan mobilization in combination with lumbar traction in addition to conventional treatment, while group D (control group) received the conventional treatment only. All participants received 3 treatment sessions per week for one month. The assessments were done before and after one month of treatment using Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI) for functional disability, and magnetic resonance image (MRI) for facet joint tropism. Statistically significant improvement was found in pain and functional disability in all four groups post-treatment (p<0.05), compared to pre-treatment, with the study groups (A, B and C) having a higher improvement than the control group (D). The improvement in group C was significantly higher than in groups A and B (p<0.05), and the improvement in group A was significantly higher than in group B (p<0.05). Regarding the facet joint tropism, there was a statistically significant improvement in the four groups post-treatment (p<0.05) compared with pre-treatment, with higher significant improvements in the study groups (A, B, C) in comparison with the control group (D). There was no statistically significant difference in tropism between groups A, B and C. The combination of Mulligan mobilization and lumbar traction (group C) was the most effective treatment for relieving pain and functional disability in patients with facet joint syndrome. Regarding facet tropism, there was a statistically significant improvement with all the treatments, but the conventional treatment produced the lowest improvement.


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Amro, A., Diener, I., Bdair, W. O., Hameda, I. M., Shalabi, A. I., & Ilyyan, D. I. (2010). The effects of Mulligan mobilisation with movement and taping techniques on pain, grip strength, and function in patients with lateral epicondylitis. Hong Kong Physiotherapy Journal, 28(1), 19–23.

Anap, D. B., Khatri, S., Zambre, B. R. (2014). Effectiveness of sustained natural apophyseal glides and maitland mobilization in facet joint syndrome: a single blind randomized control pilot study. International Journal of Health Sciences and Research, 4(10), 142-150.

Anwar, N. A., Noor, R., & Bashir, M. S. (2016). Effects of Lumbar Decompression in Patients of Low Back Pain. Journal Riphah College of Rehabilitation Sciences, 4(1), 11–14.

Beurskens, A. J., de Vet, H. C., Köke, A. J., Lindeman, E., Regtop, W., van der Heijden, G. J., & Knipschild, P. G. (1995). Efficacy of traction for non-specific low back pain: a randomised clinical trial. Lancet (London, England), 346(8990), 1596–1600.

Boden, S. D., Riew, K. D., Yamaguchi, K., Branch, T. P., Schellinger, D., & Wiesel, S. W. (1996). Orientation of the lumbar facet joints: association with degenerative disc disease. The Journal of Bone and Joint Surgery, 78(3), 403–411.

Bogduk, N., & McGuirk, B. (2002). Medical Management of Acute and Chronic Low Back pain. Elsevier.

Borman, P., Keskin, D., & Bodur, H. (2003). The efficacy of lumbar traction in the management of patients with low back pain. Rheumatology international, 23(2), 82–86.

Cheng, Y. H., Hsu, C. Y., & Lin, Y. N. (2020). The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis. Clinical rehabilitation, 34(1), 13–22.

Chung, S. B., Lee, S., Kim, H., Lee, S. H., Kim, E. S., & Eoh, W. (2012). Significance of interfacet distance, facet joint orientation, and lumbar lordosis in spondylolysis. Clinical anatomy (New York, N.Y.), 25(3), 391–397.

Cyriax, J. (1981). Textbook of orthopedic medicine. Bailliere Tindall.

Fairbank, J. C., Couper, J., Davies, J. B., & O'Brien, J. P. (1980). The Oswestry low back pain disability questionnaire. Physiotherapy, 66(8), 271–273.

Fritz, J. M., Lindsay, W., Matheson, J. W., Brennan, G. P., Hunter, S. J., Moffit, S. D., Swalberg, A., & Rodriquez, B. (2007). Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial and subgrouping analysis. The Spine Journal, 32(26), 793–800.

Ghai, S., & Ghai, I. (2014). Role of various mobilization maneuvers in the management of lowback pain. Research & Reviews in BioSciences, 8(10), 374-381.

Ghormley, R. K. (1933). Low back pain: with special reference to the articular facets, with presentation of an operative procedure. JAMA, 101(23), 1773-1777.

Goldthwait, J. E. (1911). The Lumbo-Sacral Articulation; An Explanation of Many Cases of “Lumbago,” “Sciatica” and Paraplegia. The Boston Medical and Surgical Journal, 164(11), 365–372.

Graham, N., Gross, A., Goldsmith, C., & Group, the C. O. (2006). Mechanical traction for mechanical neck disorders: a systematic review. Journal of Rehabilitation Medicine, 38(3), 145–152.

Grobler, L. J., Robertson, P. A., Novotny, J. E., & Pope, M. H. (1993). Etiology of spondylolisthesis. Assessment of the role played by lumbar facet joint morphology. The Spine Journal, 18(1), 80–91.

Hattori, M., Shirai, Y., & Aoki, T. (2002). Research on the effectiveness of intermittent cervical traction therapy, using short-latency somatosensory evoked potentials. Journal of orthopaedic science, 7(2), 208–216.

Heggannavar, A. B., & Kale, A. S. (2015). Immediate effect of modified lumbar snags in non-specific chronic low back patients: a pilot study. International Journal of Physiotherapy and Research, 3, 1018-1023.

Hidalgo, B., Pitance, L., Hall, T., Detrembleur, C., & Nielens, H. (2015). Short-term effects of Mulligan mobilization with movement on pain, disability, and kinematic spinal movements in patients with nonspecific low back pain: a randomized placebo-controlled trial. Journal of Manipulative and Physiological Therapeutics, 38(6), 365–374.

Hing, W., Hall, T., Rivett, DA., Vicenzino, B., & Mulligan, B. (2015). The Mulligan Concept of Manual Therapy. Elsevier.

Hussien, H. M., Abdel-Raoof, N. A., Kattabei, O. M., & Ahmed, H. H. (2017). Effect of Mulligan Concept Lumbar SNAG on Chronic Nonspecific Low Back Pain. Journal of Chiropractic Medicine, 16(2), 94–102.

Pérez, H. I., Perez, J. L. A., Martinez, A. G., Touche, R. L., Lerma-Lara, S., Gonzalez, N. C., Perez, H. A., Bishop, M. D., & Fernández-Carnero, J. (2014). Is one better than another? A randomized clinical trial of manual therapy for patients with chronic neck pain. Manual therapy, 19(3), 215–221.

Jackson, T., Wang, Y., Wang, Y., & Fan, H. (2014). Self-efficacy and chronic pain outcomes: a meta-analytic review. The Journal of Pain, 15(8), 800–814.

Kalichman, L., Suri, P., Guermazi, A., Li, L., & Hunter, D. J. (2009). Facet orientation and tropism: associations with facet joint osteoarthritis and degeneratives. The Spine Journal, 34(16), 579–585.

Kamanli, A., Karaca-Acet, G., Kaya, A., Koc, M., & Yildirim, H. (2010). Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation. Bratislavske lekarske listy, 111(10), 541–544.

Kisner, C., & Colby, LA. (2012). Therapeutic exercise: foundations and techniques. F. A Davis.

Konstantinou, K., Foster, N., Rushton, A., Baxter, D., Wright, C., & Breen, A. (2007). Flexion mobilizations with movement techniques: the immediate effects on range of movement and pain in subjects with low back pain. Journal of Manipulative and Physiological Therapeutics, 30(3), 178–185.

Latif, N.A., Garib, N.M., & Adel, S. (2015). Efficacy of Spinal Manipulation as A Part Of Physical Therapy Program In Patients With Lumbar Disc Herniation: A Randomized Controlled Trial. Journal of Medical Science and Clinical Research, 3(5), 5768-5779.

Lee, R. Y., & Evans, J. H. (2001). Loads in the lumbar spine during traction therapy. Australian Journal of Physiotherapy, 47(2), 102–108.

Lee, R., & Evans, J. (1997). An in vivo study of the intervertebral movements produced by posteroanterior mobilization. Clinical Biomechanics (Bristol, Avon), 12(6), 400–408.

Manchikanti, L., & Pampati, V. (2002). Research designs in interventional pain management: is randomization superior, desirable or essential? Pain Physician, 5(3), 275–284.

Manchikanti, L., Staats, P. S., Singh, V., Schultz, D. M., Vilims, B. D., et al., (2003). Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician, 6(1), 3–81.

McAtee, R. (2013). Facilitated Stretching. Human Kinetics.

Moeti, P., & Marchetti, G. (2001). Clinical outcome from mechanical intermittent cervical traction for the treatment of cervical radiculopathy: a case series. Journal of Orthopaedic and Sports Physical Therapy, 31(4), 207–213.

Moutzouri, M., Perry, J., & Billis, E. (2012). Investigation of the effects of a centrally applied lumbar sustained natural apophyseal glide mobilization on lower limb sympathetic nervous system activity in asymptomatic subjects. Journal of Manipulative and Physiological Therapeutics, 35(4), 286–294.

Mulligan, B. (2004). Manual Therapy: “NAGS”, “SNAGS”, “MWMS”, etc. Wellingt, Newzealand.

Naderi, S., Ekinci, G., Bayri, Y., Derakhshani, S., Özgen, S., & Pamir, MN. (1997). Facet joint angle in lumbar disc herniation. The Journal of Turkish Spinal Surgery, 8(4), 136-139.

Olivero, W. C., & Dulebohn, S. C. (2002). Results of halter cervical traction for the treatment of cervical radiculopathy: retrospective review of 81 patients. Neurosurgical Focus, 12(2).

Ozturk, B., Gunduz, O. H., Ozoran, K., & Bostanoglu, S. (2006). Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation. Rheumatology International, 26(7), 622–626.

Reid, S. A., Rivett, D. A., Katekar, M. G., & Callister, R. (2008). Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Manual Therapy, 13(4), 357–366.

Schimmel, J. J., de Kleuver, M., Horsting, P. P., Spruit, M., Jacobs, W. C., & van Limbeek, J. (2009). No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy. European Spine Journal, 18(12), 1843–1850.

Scrimshaw, S. V., & Maher, C. (2001). Responsiveness of visual analogue and McGill pain scale measures. Journal of manipulative and physiological therapeutics, 24(8), 501–504.

Seo, U. H., Kim, J. H., & Lee, B. H. (2020). Effects of Mulligan Mobilization and Low-Level Laser Therapy on Physical Disability, Pain, and Range of Motion in Patients with Chronic Low Back Pain: A Pilot Randomized Controlled Trial. Healthcare (Basel, Switzerland), 8(3), 237.

Solomonow, M., Zhou, B. H., Harris, M., Lu, Y., & Baratta, R. V. (1998). The ligamento-muscular stabilizing system of the spine. The Spine Journal, 23(23), 2552–2562.

Teys, P., Bisset, L., & Vicenzino, B. (2008). The initial effects of a Mulligan's mobilization with movement technique on range of movement and pressure pain threshold in pain-limited shoulders. Manual therapy, 13(1), 37–42.

van Schaik, J. P., van Pinxteren, B., Verbiest, H., Crowe, A., & Zuiderveld, K. J. (1997). The facet orientation circle. A new parameter for facet joint angulation in the lower lumbar spine. The Spine Journal, 22(5), 531–536.

Vicenzino, B., Hing, W., Rivett, D., & Hall, T. (2011). Mobilisation with Movement: The Art and the Science. Elsevier Australia.

Cómo citar
Elgendy, M. H. ., Habib, A. A. ., Ibrahim, R. E. ., & Lasheen, Y. R. . (2022). Mulligan mobilization versus traction in lumbar facet joint syndrome: randomized controlled trial. SPORT TK-Revista EuroAmericana de Ciencias del Deporte, 11, 1.