The Effects of Spinal Mobilization Added to an Exercise Program in Recreational Tennis Players With Mechanical Low Back Pain

NCT07573254 | Completed

• 1 other identifier: Tennis - Spinal Mob 25-49
• Study Type: interventional
• Target: 31
• Locations: 1 country
• Sites: 1

Brief Summary

This prospective, single-blind, randomized controlled trial investigates whether the addition of spinal mobilization to a structured home exercise program improves pain, flexibility, lower-extremity strength, dynamic balance, and jump performance in recreational tennis players (aged 18-45 years; BMI 18-30 kg/m²) with non-radiating mechanical low back pain. Participants were allocated to two parallel groups: a Control Group performing a 21-session home exercise program for 3 weeks, and an Experimental Group performing the same program plus four physiotherapist-administered spinal mobilization sessions (one at baseline and one weekly for 3 weeks). Outcomes were the Visual Analog Scale (VAS) for pain during physical activity, at rest, and at night; the Y-Balance Test; the Vertical Jump Test; the Sit-and-Reach Test; and isometric strength measured with a back-chest-leg dynamometer.

Conditions

Low Back Pain, Mechanical; Recreational Physical Activity; Tennis; Manual Therapy; Therapeutic Exercise; Physiotherapy and Rehabilitation

Keywords

low back pain; tennis; manual therapy; therapeutic exercise; Physiotherapy and rehabilitation

Outcome Measures

Primary Outcomes (1)

• Visual Analog Scale (VAS) for pain during physical activity (cm

  Self-reported pain intensity during physical activity recorded on a 10-cm horizontal Visual Analog Scale anchored from 0 ("no pain") to 10 ("worst imaginable pain"). Lower values indicate less pain. Safety Issue: No.

  Baseline to Week 3

Secondary Outcomes (6)

• Visual Analog Scale (VAS) for pain at rest (cm)

  Baseline to Week 3

• Visual Analog Scale (VAS) for night pain (cm)

  Baseline to Week 3

• Y-Balance Test (cm)

  Baseline to Week 3

• Vertical Jump Test (cm)

  Baseline to Week 3

• Sit-and-Reach Test (cm)

  Baseline to Week 3

Study Arms (2)

Control Group (CG):Home Exercise Program Only

ACTIVE COMPARATOR

Structured home-based exercise program performed daily for 3 weeks (21 sessions). The program included posterior pelvic tilt, double knee-to-chest erector spinae stretching, combined hamstring and lumbar extensor stretching (long-sit toe touch), piriformis stretching, and static hamstring stretching. Adherence was supported by written instructions, visual materials, and weekly telephone follow-up.

Behavioral: Home Exercise Program

Experimental Group (EG): Spinal Mobilization Plus Home Exercise Program

EXPERIMENTAL

The identical home exercise program (21 sessions over 3 weeks) plus four sessions of supervised spinal mobilization administered by a physiotherapist - one at baseline and one per week for 3 weeks - using Maitland-graded techniques (Levels I-V; end-range not forced).

Behavioral: Home Exercise Program; Procedure: Spinal Mobilization (Maitland-Graded Manual Therapy)

Interventions

Home Exercise Program BEHAVIORAL

21 daily sessions over 3 weeks; 5 repetitions per exercise (30-second holds for stretches; 10-second hold for posterior pelvic tilt); supported by written instructions, visual materials, and weekly telephone follow-up.

Control Group (CG):Home Exercise Program Only; Experimental Group (EG): Spinal Mobilization Plus Home Exercise Program

Spinal Mobilization (Maitland-Graded Manual Therapy) PROCEDURE

Four supervised sessions over 3 weeks (one at baseline and weekly thereafter). Techniques included thoracic posteroanterior mobilization (T5-T12), rotational thoracic mobilization ("butterfly/screw"), sacroiliac mobilization, side-lying lumbar mobilization, and anteroposterior lumbar mobilization. Each technique was applied as five sets of one-minute oscillations with 20-second rest intervals in the posteroanterior, mediolateral, and transverse planes.

Experimental Group (EG): Spinal Mobilization Plus Home Exercise Program

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Adults aged 18-45 years.
• Body mass index (BMI) between 18 and 30 kg/m².
• Mechanical low back pain that decreases in the supine position and increases with activity or in various postures.
• Low back pain of more than one week duration with a baseline intensity greater than 4 on the Visual Analog Scale (VAS) and unrelated to any defined medical condition.
• Playing tennis on a recreational basis at least 2 days per week, totalling at least 2 hours per week.
• Able to communicate in Turkish or English in both written and spoken form.

You may not qualify if:

• Pain in the lower back, hip, or groin lasting longer than 6 months.
• Pain accompanied by a sensory deficit.
• Pain radiating to the hip or lower extremity.
• History of long-term steroid use.
• Regular medication use.
• History of injury or surgery resulting in residual deficits.
• Previous interventional treatment to the lumbar region.
• Pregnancy or suspected pregnancy.
• Termination Criteria During Study:
• Onset of an acute illness requiring treatment (e.g., influenza, pneumonia).
• Use of analgesic or sedative medication.
• An increase in VAS pain score greater than 3 points during exercise or treatment.
• Failure to perform the home exercise programme on three consecutive days.
• Missed manual therapy session.

Sponsors & Collaborators

• Istinye University: lead

Study Sites (1)

Istinye University

Istanbul, Turkey (Türkiye)

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: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Outcome assessments were performed by a single assessor blinded to group allocation.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: assistant professor, PhD

Model Details: Single-blind randomized controlled trial with two parallel arms; allocation by computer-assisted randomization with sealed opaque envelopes.

Study Record Dates

• First Submitted: May 1, 2026
• First Posted: May 7, 2026
• Study Start: April 1, 2025
• Primary Completion: August 1, 2025
• Study Completion: August 20, 2025
• Last Updated: May 7, 2026

Record last verified: 2026-05

Locations

TU (1)