Effectiveness of mobilization with movement (Mulligan concept techniques) on low back pain: a systematic review

Objective: To evaluate evidence on the effectiveness of Mulligan techniques on low back pain. Data sources: PubMed/Medline, Scopus, Ovid, CINAHL, Embase, PEDro, Google Scholar, and Cochrane Library were searched from inception to 31 March 2018 for randomized clinical trials reporting outcomes of pain or disability in adult patients (⩾18 years) with low back pain. Review methods: Two authors screened the results and extracted data for use in this review. The risk of bias was evaluated using the Cochrane criteria. Basic information and treatment protocols were also extracted. In addition, the level of evidence of each study and strength of conclusion for pain and disability were determined. Results: A total of 20 studies with 693 patients were included. Nine trials focused on sustained natural apophyseal glide, three on spinal mobilization with limb movement and seven on bent leg raise. The results showed that Mulligan techniques can decrease pain and disability and increase range of motion in patients with low back pain; however, the strength of conclusion for pain and disability was moderate. Furthermore, inconclusive results were observed for the effectiveness of Mulligan techniques on movement speed. In this review, eight studies were categorized as low risk of bias, while 12 studies had high risk of bias. Level of evidence analysis revealed that 17 studies were classified as level of evidence B, while three studies were classified as level of evidence A2. Conclusion: Current evidence is insufficient in supporting the benefits of Mulligan techniques on pain, disability, and range of motion in low back pain patients. © 2018, The Author(s) 2018