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

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 ± 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 follow-up; 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.