Maitland Mobilization vs. McKenzie Press-Up in Chronic LBP

NCT07364721 | Completed DMC

• 1 other identifier: Palestine Ahliya U
• Study Type: interventional
• Target: 50
• Locations: 1 country
• Sites: 1

Brief Summary

ABSTRACT Objective:This study aimed to compare the efficacy of central posteroanterior (PA) Maitland mobilization with myofascial release (MFR) and McKenzie prone press-up (PPU) exercise with MFR in the treatment of adult patients with chronic non-specific low back pain (CNLBP). Materials and Methods:A randomized controlled trial was conducted at Salhab Center and Al Shifa's Specialized Complex in Bethlehem between January 2023 and May 2024. The study included 50 adult patients (aged 18-50) with CNLBP of more than 3 months but less than 2 years' duration, referred by an orthopedic specialist at Beit Sahour Medical Center. Participants were randomly assigned to two groups: one received central PA Maitland mobilization with MFR, and the other received McKenzie PPU exercise with MFR. Pain intensity, functional impairment, and fear-avoidance beliefs were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Fear-Avoidance Beliefs Questionnaire (FABQ). Each patient underwent three sessions per week for four weeks.

Conditions

Back Pain Lower Back

Keywords

McKenzie Exercise; Low back pain; Posteroanterior mobilization

Outcome Measures

Primary Outcomes (1)

• Oswestry Disability Index

  0% (no disability) to 100% (severe disability)

  4 WEEKS

Other Outcomes (2)

• Visual Analogu Scale

  4 WEEKS

• Fear-Avoidance Belief Questionnaire

  4 WEEKS

Study Arms (2)

Arm 1- Group A :Central PA Maitland mobilization with MFR

EXPERIMENTAL

Central PA Maitland mobilization with MFR

Other: Group B (McKenzie PPU exercise with MFR); Other: McKenzie PPU exercise with MFR

Arm 2- Group B:McKenzie PPU exercise with MFR

EXPERIMENTAL

Patient position: The patient assumes a prone position. investigator position: The investigator stands beside the patient and provides verbal instruction. Direction: Patients were being instructed to perform PPU exercise by using their upper limbs to push their upper body up into spinal extension while the pelvis remained on the treatment table. The patient is trained to extend the lumbar spine to the maximum pain-free range. Frequency: Ten repetitions for three sets with a 30-second break between each set for almost 10 minutes \[27\].

Other: Group B (McKenzie PPU exercise with MFR); Other: Central Posteroanterior Mobilization

Interventions

Group B (McKenzie PPU exercise with MFR) OTHER

Patient position: The patient assumes a prone position. Therapist position: The therapist stands beside the patient and provides verbal instruction. Direction: Patients were being instructed to perform PPU exercise by using their upper limbs to push their upper body up into spinal extension while the pelvis remained on the treatment table. The patient is trained to extend the lumbar spine to the maximum pain-free range. Frequency: Ten repetitions for three sets with a 30-second break between each set for almost 10 minutes

Arm 1- Group A :Central PA Maitland mobilization with MFR; Arm 2- Group B:McKenzie PPU exercise with MFR

Central Posteroanterior Mobilization OTHER

According to Maitland's concept, mobilization technique including passive accessory intervertebral movement was applied to cause movement in the stiff vertebral segment without the active involvement of the muscles \[44\]. Central PA mobilization technique is a cornerstone of Maitland vertebral mobilization \[38\]. It can be achieved by passive force onto a vertebral segment in the PA direction \[44\]. Patient position: When applying this technique, the patient assumes a relaxed and comfortable prone position, with the arms positioned alongside the body \[23, 24\]. investigator position: The investigator stands close to the patient, with their sternum perpendicular to the selected lumbar spinous process \[23\]. The investigator uses the ulnar surface of the hand (pisiform) over the selected spinous process in the lumbar spine, another hand taken was placed above the first hand to reinforce, and the elbow should slightly bent with forearm in neutral between supination \& pronation.

Arm 2- Group B:McKenzie PPU exercise with MFR

McKenzie PPU exercise with MFR OTHER

Patient position: The patient assumes a prone position. investigator position: The investigator stands beside the patient and provides verbal instruction. Direction: Patients were being instructed to perform PPU exercise by using their upper limbs to push their upper body up into spinal extension while the pelvis remained on the treatment table. The patient is trained to extend the lumbar spine to the maximum pain-free range. Frequency: Ten repetitions for three sets with a 30-second break between each set for almost 10 minutes

Arm 1- Group A :Central PA Maitland mobilization with MFR

Eligibility Criteria

• Age: 18 Years - 50 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• and 50 years of age,
• Male or female, with NSLBP localized between the lower rib and the gluteal fold
• Persisting for more than three months and occurring on at least half of the days in the past three months, with pain affecting daily functional activities.
• VAS score between 40 mm and 80 mm at the initial assessment
• No use of NSAID medications during treatment sessions.

You may not qualify if:

• Patients younger than 18 or older than 50 years,
• Those with mental health disorders, systemic or neurological diseases, or specific spinal pathologies such as facet joint dysfunction, piriformis syndrome, disc herniation, spinal tumors, spondylitis, spondylolisthesis, spinal stenosis, or spinal osteoporosis. Patients were also excluded if they had contraindications to mobilization, a history of spinal surgery or epidural injections, physiotherapy for LBP within the last six months, a VAS score outside the 40-80 mm range, pregnancy, or a current upper limb injury.

Sponsors & Collaborators

• Palestine Ahliya University: lead

Study Sites (1)

Palestine Ahliya University

Bethlehem, West Bank, P150, Palestinian Territories

Location

MeSH Terms

Conditions

Low Back Pain

Condition Hierarchy (Ancestors)

Back Pain; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Chairperson, Department of Medical Sciences - Master's

Model Details: The treatment techniques applied to the two groups are as follows. Group A (Central PA Maitland mobilization with MFR): 25 patients received 3 sessions per week for 4 weeks; the central PA mobilization technique was applied for 10 minutes and MFR for 20 minutes (30 seconds break each five minutes). Group B (McKenzie PPU exercise with MFR): 25 patients received three sessions per week for four weeks, with each session consisting of 10 minutes of McKenzie PPU exercise followed by 20 minutes of MFR, also with a 30-second break every five minutes.

Study Record Dates

• First Submitted: January 3, 2026
• First Posted: January 23, 2026
• Study Start: December 1, 2023
• Primary Completion: April 1, 2024
• Study Completion: May 1, 2024
• Last Updated: January 23, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)