Mid-term Effect of Lumbar Sustained Natural Apophyseal Glides in Patients with Non-specific Chronic Low Back Pain: A Randomized Clinical Trial

Abstract

Objective: The objective of this study was to compare the standalone and combined mid-term effects of conventional physiotherapy and lumbar sustained natural apophyseal glides on pain, range of motion, fear avoidance belief, and functional status in patients with non-specific chronic low back pain. Materials and Methods: This randomized clinical study was conducted in a state hospital. Fifty-five patients with non-specific chronic low back pain (mean age: 40.69 & PLUSMN; 6.27 years) were divided into 3 groups. Group I (n = 18) received conventional physiotherapy (electrotherapy and heat application) 5 days a week for 3 weeks, group II (n = 19) received lumbar sustained natural apophyseal glides 3 days a week for 3 weeks. Group III (n = 18) received conventional physiotherapy plus lumbar sustained natural apophyseal glides. Pain (visual analog scale), flexion range of motion (back range of motion II), functional status (Roland-Morris Disability Questionnaire), and fear avoidance belief (Fear Avoidance Belief Questionnaire) were assessed at baseline, third week, and 6-month follow-up.Results: After 3 weeks of intervention, all outcome measures improved in groups II and III. These improvements remained significant until 6-month follow-up (P < .05), except fear avoidance belief (P = .06) and flexion range of motion (P = .764) scores of group III. Flexion range of motion (P = .001), functional status (P = .001), and fear avoidance belief (P = .03) differed significantly between the 3 groups at 6-month followup; post-hoc analysis revealed that flexion range of motion (P < .0001), functional status (P = .037), and fear avoidance belief (P = .002) scores were significantly improved in group II compared to group I.Conclusion: Compared with conventional physiotherapy, lumbar sustained natural apophyseal glides improved mid-term range of motion, functional status, and fear avoidance belief, but there was no difference in pain. Conventional physiotherapy added to lumbar sustained natural apophyseal glides provided no additional benefit.