EFFECTIVENESS OF MULLIGAN SNAGS VS MAITLAND MOBILIZATION IN LUMBAR DISC BULGE: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background:
Lumbar disc bulge is one of the most common causes of low back pain and functional disability worldwide. Manual therapy techniques, particularly Mulligan Sustained Natural Apophyseal Glides (SNAGs) and Maitland mobilization, are frequently used in physiotherapy management. However, comparative evidence regarding their effectiveness in patients with lumbar disc bulge remains limited.

Objective:
To compare the effectiveness of Mulligan SNAGs and Maitland mobilization in reducing pain and disability among patients with lumbar disc bulge.

Methods:
A randomized controlled trial was conducted at the Department of Physical Therapy of a tertiary care hospital between January and June 2025. Sixty patients diagnosed with lumbar disc bulge confirmed by MRI were randomly allocated into two groups (n=30 each). Group A received Mulligan SNAGs along with conventional physiotherapy, while Group B received Maitland mobilization with the same conventional treatment. Interventions were administered three sessions per week for four weeks. Outcome measures included the Visual Analog Scale (VAS) for pain and the Oswestry Disability Index (ODI) for functional disability. Assessments were conducted at baseline and after four weeks of intervention. Data were analyzed using SPSS version 26. Independent and paired t-tests were applied, with significance set at p < 0.05.

Results:
Both groups demonstrated significant improvement in pain and disability following the intervention (p < 0.001). However, the Mulligan SNAGs group showed greater reduction in VAS scores (mean difference: 4.1 ± 1.2) compared with the Maitland mobilization group (3.2 ± 1.1) (p = 0.02). Similarly, ODI scores improved significantly in both groups, with a greater improvement observed in the Mulligan group (p = 0.03).

Conclusion:
Both Mulligan SNAGs and Maitland mobilization are effective in reducing pain and disability in patients with lumbar disc bulge. However, Mulligan SNAGs demonstrated superior clinical outcomes compared with Maitland mobilization over a four-week intervention period.