Background: If the weakness of the knee muscles persists and there is pain at the same time, lumbar mobilization can be used. Objectives: This study investigated the immediate effect of lumbar joint mobilization on postural sway and knee pain in elite volleyball players. Design: Randomized controlled trial. Methods: Twelve male elite volleyball players were recruited for this study. Lumbar joint mobilization was performed in all study subjects. Evaluation items were static and dynamic balance and knee pain change. All evaluations were made immediately after the intervention. Results: C90 area, trace length, and STD Y deviation in the open static balance were significantly decreased after intervention (P<.05). C90 area, trace length, Velocity, STD X deviation, and STD Y deviation in static balance with closed eyes decreased significantly after intervention (P<.05). In dynamic balance, the left and right side. COPs were significantly increased. Pain significantly decreased after intervention (P<.05). Conclusion: This study found that lumbar joint mobilization is an effective method for improving postural sway and knee pain in elite volleyball players.

Background: A recent study found that pain neuroscience education (PNE) alters pain intensity, knowledge of pain, disability, psychological function, and pain behavior in patients with musculoskeletal pain. However, they noted that PNE alone was not sufficient to affect chronic low back pain (CLBP) reduction. Objectives: To investigated the effect of CLBP on the PNE combined with lumbar mobilization. Design: Quasi-experiment study. Methods: A total of 33 patients aged 25 to less than 65, recruited from L-hospital for low back pain in Chungcheongnam-do. Out of 33 subjects, 17 were pain neuroscience education combined with lumbar mobilization group (PLMG) and 16 were lumbar mobilization group (LMG). The outcome was visual analogue scale (VAS), oswestry disability index (ODI) and the fear avoidance beliefs questionnaire (FABQ). The collected data was analyzed using the SPSS ver. 21.0 program by paired t-test and independent t-test. Results: PLMG was indicated statistically significant decrease in VAS, ODI and FABQ before and after intervention. However, there were statistically significant changes in VAS and ODI before and after intervention in LMG. PLMG and LMG before and after intervention indicated statistically significant differences in VAS, ODI and FABQ. Conclusion: The inclusion of PNE combined with lumbar mobilization in patients with CLBP is a promising and feasible approach to the management of CLBP.

Background: There is a research report that lumbar mobilization for healthy people improves the knee extension angles and Q-angle related muscle activity (Q: quadriceps muscle). However, there is a lack of research on the effect of lumbar mobilization on gait variables such as cadence and gait speed, especially when mobilizing the central part of the lumbar spine from posterior to anterior. Objectives: To examine the effect of lumbar central PA mobilization in healthy people on cadence and gait speed. Design: Pilot study. Methods: There were 34 participants in this study. In the experimental group, lumbar posterior-anterior joint mobilization was performed once in Grade III-IV for 5 minutes, focusing on the segment with reduced movement. In the control group, lumbar posteroanterior mobilization was performed once in a total of Grade I-II for 5 minutes. To measure cadence and gait speed, STT-IWS and iSen System (San Sebastian, Spain) were used. Results: The comparison of cadence between groups, CG (Control group) increased cadence was about 6 more than EG (Experimental group) cadence, but it was not statistically significant. The gait speed of EG and CG was .30- .31, which was similar between the two groups, and the before and after values were also similar. There is no statistically significant difference Conclusion: The cadence and gait speed of the experimental group were not statistically significantly different than those of the placebo group.

Background: Patients with lumbar spinal stenosis show abnormal changes in muscle activity due to pain and limited range of motion of the lumbar spine. Excessive increased muscle tone and decreased muscle activity patterns threaten the patients’ quality of life. However, there have been a few studies showing how to improve muscle performance in patients with lumbar spinal stenosis. Among these, joint mobilization is one way of improving muscle performance through pain relief and increasing the range of motion. Objectives: To investigate the effect of lumbar mobilization by orthopedic manual physical therapy on paravertebral muscle activity and tone in patients with lumbar spinal stenosis. Design: A randomized controlled trial. Methods: In this study, 24 patients with lumbar spinal stenosis were randomized (1:1 ratio) into two groups. The experimental group underwent lumbar posteroanterior mobilization, and the control group underwent conventional physical therapy (conventional transcutaneous electrical nerve stimulation) for 15 minutes each. For outcome measures, MyotonⓇPRO was used to evaluate muscle tone when resting of the paravertebral muscle in the pain area. For muscle activity evaluation, the reference voluntary contraction of the paravertebral muscle was evaluated using surface electromyography. Results: Muscle tone and activity were significantly improved after intervention in both the experimental and control groups. In addition, the experimental group showed more significant decrease in muscle tone and activity than the control group. Conclusion: These results suggest that lumbar mobilization improving muscle performance in patients with lumbar spinal stenosis.

Background: The spinal nerves, which start at the lumbar level, are connected to the nerve innervation in the knees. Currently, there is a lack of research on the treatment of knee pain through lumbar mobilization. Objectives: To investigate the effects of lumbar joint mobilization (LJM) and transcutaneous electronic nerve stimulation (TENS) on proprioception and muscular strength in volleyball players with chronic knee pain. Design: Two group pre-posttest. Methods: A total of 26 professional volleyball players with chronic knee pain were allocated to the LJM (n=13) and TENS (n=13) groups. In the LJM group, grade III - IV amplitude was applied 3 times for 1 minute (80 times per minute) at the affected lumbar (L2-3) facet joint in the prone position. In the TENS group, the TENS treatment device was used to directly apply or 15 minutes to the area of chronic knee pain (100 Hz, 150 ㎲). Proprioception was measured by knee flexion and extension angles, and muscle strength was evaluated using an isokinetic test. Measurements were taken before and after interventions. Results: In the eye opened conditiond, proprioception significantly increased during both knee extension and flexion after LJM, while only knee extension was significantly increased in the TENS group. There was also a significant difference in knee extension between the two groups. In the eye close conditiond, proprioception was significantly improved only during knee extension in the LJM group, and the difference in knee extension between the groups was also significant (P<.05). The maximum torque of the affected knee joint was significantly improved at 60°/sec in both groups (P<.05); however, there was no difference between the two groups. There was no significant difference in the maximum flexion torque within or between the groups. Conclusion: This study suggests that LJM improved proprioception and muscular strength in volleyball players with chronic knee pain.

Background: The effect of mobilization on lumbar back pain has been fully described in several clinical aspects, but evidence for muscle strength would be still less clear. Objective: To assess the effect of lumbar mobilization on lower limb strength in healthy individuals. Methods and Analysis: Healthy people aged 18-65 will be included regardless of race or sex. Original peer-reviewed primary reporting randomized controlled trials (RCTs) will be included. Electronic databases, such as MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Pedro, CINAHL, ClinicalTrials.gov will be searched from inception until July 30. Only studies published in English will be included in this review. Two reviewers will complete the screening for eligibility independently, and the other two reviewers will also complete the risks of data extraction and bias assessment independently. Lower Limb strength will be assessed as primary outcome, and particular intervention or participant characteristics will be assessed as the secondary outcomes. Meta-analysis will be conducted using Review Manager 5.3.3, and evidence level will be assessed using the method for Grading of Recommendations Assessment, Development and Evaluation. Outcomes will be presented as the weighted mean difference or standardized mean difference with 95% CI. If I2 ≤ 50%, P>.1, the fixed effect model will be used, otherwise, random-effects model will be used. Ethics and dissemination: This review might not be necessary ethical approval because it does not require individual patient’s data; these findings will be published in conference presentations or peer-reviewed journal articles. PROSPERO registration number: CRD42020150144.

Background: Surgery has been known as an inefficient approach to reduce back pain in patients with lumbar spinal stenosis; therefore, non-surgical treatments are necessary. However, there has been little research to analyze the effect of non-surgical treatments on lumbar spinal stenosis pain. Objective: To identify the effectiveness of 2 physiotherapeutic treatment approaches to relieve pain due to lumbar spinal stenosis. Design: Randomized controlled trial Methods: The participants were 36 lumbar spinal stenosis patients who were randomized in the joint mobilization group (JMG) and transcutaneous electrical nerve stimulation group (TENSG). Joint mobilization (JM) was conducted at the posteroanterior joint in the spinous process of the lumbar spine with stenosis. Transcutaneous electrical nerve stimulation (TENS) was applied on the lumbar spine with stenosis at a high frequency and intensity. Results: Visual analog scale (VAS) pain score significantly decreased in both groups, and the VAS value decreased more after JMG than that after TENSG. The pain thresholds of both groups also significantly increased, and that of JMG increased more compared to TENSG. In both the groups, significant improvements in VAS and pain thresholds were found, and JMG showed better results than TENSG. Conclusions: JM and TENS showed significant relief in both pain threshold and painpain, and JM showed more advanced relief compared to TENS.

Background: Previous researchers have investigated the mechanical and neurophysiological effects of manual mobilization, however little research has been done on muscle tone and muscle stiffness. Objective: To compare the effects of posterior-anterior (PA) mobilization with weight bearing on sling and conventional PA mobilization on the bed. Design: Randomized controlled trial (single blind) Methods: The subjects were 16 male university students and randomized to sling mobilization group (SMG, n=8) or conventional mobilization group (CMG, n=8). SMG received PA mobilization using a sling and CMG received traditional mobilization on the bed during lumbar mobilization. Results: Both left and right muscle tones of SMG increased, but left muscle tone of SMG were increased and right muscle tone was decreased after intervention. In addition, both left and right muscle stiffness of SMG were also increased, however left muscle stiffness of SMG was increased and right muscle stiffness was decreased. The muscle tone and muscle stiffness of SMG were higher than those of DMG, especially the right side was statistically significantly higher. Extension of SMG, extension and flexion of CMG were increased statistically significantly except for Flexion of SMG (p<.05). There were no significant differences between the groups in Extension and Flexion. Conclusions: This study suggests that lumbar spine PA mobilization using sling is beneficial in improving muscle tone, muscle stiffness, and trunk movement.

The purpose of this study was to investigate the short-term effects of lumbar rotational mobilization under the single-leg standing (SLS) position. Fifteen healthy individuals were recruited, and randomized to agroup of trunk rotational exercise (TRE) and lumbar rotational mobilization (LRM). Trunk twist rotational exercise was performed to the TRE group, and mobilization was applied to the LRM group on the lumbar spine. Velocity of the center of pressure (VCOP) and center of pressure (COP) for each participant were measured through SLS. COPs were not significantly increased or decreased after treatment in both groups. VCOPs also did not change considerably except on the right side when the eye was closed. There was no significant difference between COPs and VCOPs in two groups. This study suggests that trunk rotation exercise and lumbar rotation mobilization would have similar effects on balance ability.

The original focus of this study was to investigate the immediate effects of lumbar rotational mobilization on the one-legged standing ability. Fifteen subjects (6 men and 9 women, mean age = 22.77 (SD = 1.21), mean height = 165.46cm (SD = 11.65), mean weight = 61.46kg (SD = 8.29) volunteers from healthy individuals were recruited and randomized to a lumbar rotational mobilization (LRM) group and a trunk rotational exercise (TRE) group. Mobilization (grade 3 or 4) was applied to the LRM group on the lumbar spine (L1 to L5) in a side-lying, and trunk twist exercise (left and right side) was applied the to the TRE group with lunge position. Center of pressure (COP) and the velocity of the center of pressure (VCOP) of each participant were measured as a balance ability through one leg standing position. Results are as follows. In within-group difference, the COP of the LRM group reduced during standing with the right foot, but the VCOP change of the LRM was not statistically significant. In between-groups difference, COP of TRE group was decreased compared with LRM group only during left leg standing in the eyes (p <.05). The results of this study suggest that LRM is more effective than TRE in improving balance ability.

The main focus of this study was to investigate effects of lumbar central posteroanterior (PA) mobilization on isometric knee extension (IKE) ability and patellar tendon reflex amplitude (PTRA) in healthy university students. University students aged 19-26 (male; 10, female; 10) without any neurological disorders participated voluntarily and excluded the subjects with abnormal reflexes. The participation had an average body mass of 64.25±13.52 kg, an average height of 1.66±0.08m, and an average Body Mass Index (BMI) of 23.07±3.21. Every student was randomly assigned to be received squatting exercise and PA mobilization sequentially with 5 days of wash out period. IKE and PTRA were not significantly different between the two groups after the intervention. All the outcome measures were arranged into two data groups; PA mobilization and squatting exercise data group. In the PA mobilization data group, IKE and PTRA significantly increased after the intervention, however, these aspects were decreased in the squatting exercise group. These findings suggest that IKE and PTRA increase immediately after PA mobilization, therefore PA mobilization could be a valuable topic for controlled clinical trials.

The purpose of this study was to measure the mean peak mobilization forces to the lumbar spine 1-3 with grade III and grade IV of posteroanterior (PA) mobilization. Twenty subjects with no history of Lumbar back pain (LBP) (10 female, 10 male) with a mean age of 24.1 years (SD = 6.0) were recruited for the study and PA mobilization were performed in each spine and the therapist took approximately 2.5s to complete mobilization. In the results, applied grade IV force showed no different according to each segment in LS1, LS2, LS3, however, there are distinct differences between LS1 and LS2, LS1 and LS3 during mobilization with grade III force. This study suggested that the mean peak force of the grade III and grade IV mobilization in the L1-L3 was almost similar each other.

The purpose of this study was to investigate the effects of central posteroanterior mobilization on the pain, muscle tone, flexibility of trunk flexion, lumbar lordosis in patient with chronic back pain has been studied. The target subject was a 23 year old man, who had chronic back pain without surgical history within six months. The pain has been indicated by the pressure pain threshold, when the subject was pressed his spinous process of L3-L1 by the pressure of grade Ⅳ. The muscle tone, elasticity, and stiffness were measured by the MYOTONEⓇ PRO, and the flexibility of trunk flexion was evaluated by the distance from the figure tips to the floor, when subjects flexed their body. The lumbar lordosis was measured from the X-ray picture. The lumbar central posteroanterior mobilization of Maitland orthopedic physical therapy has been applied to the spinous process of L3-L1 in grade Ⅳ by five sets and 10 times for each set. According to the measurement result right after the intervention, the pain decreased from 2/10 to 1/10 based on the visual analogue scale. The flexibility of trunk flexion (distance from the finger tips to the floor) increased The muscle tone decreased from 15.3 to 14.65 and the muscle stiffness also decreased 53.5 from 310 to 256.5. However, the muscle elasticity increased from 0.89 to 1.04 and there was no changed on the lumbar lordosis as 25°. The results of the present study suggest that the central posteroanterior mobilization decrease the pain, muscle tone, and muscle stiffness of the lumbar area, however increase the muscle elasticity and flexibility of the trunk flexion.

The Purpose of this study was to determine the effects of sciatic nerve mobilization on pain and lower back muscle strength in female patients in their 40s who have been diagnosed with lumbar radiculopathy. Using a simple blinded method, 20 female patients with neuropathy in the nerve segments between L4-S1 were randomly divided into one group (n=10) that would undergo sciatic nerve mobilization, and another group (n=10) that would perform lower back segment stabilization exercises. The two groups attended 3 sessions per week, with each session taking 30 minutes, for a duration of 4 weeks. In the preliminary examinations, the pain index as well as the isometric muscle strength of the lower back extensor and flexor muscles were measured. After the passing of 4 weeks. The same method of measurement was used for the concluding examinations. Comparison of the pain indices in the two groups revealed that they both experienced a statistically significant decrease, and further inspection revealed that the there was a more substantial difference in the sciatic nerve mobilization group. Results of comparing changes in the Isometric Muscle Strength lower back muscle and bending muscle by group, In comparison between groups, the isometric strength of the lower back extensor showed a more significant difference in the sciatic nerve mobilization group (p <.05). Conclulsion, it can be inferred that application of sciatic nerve mobilization has a positive effect on the pain index and isometric muscle strength of the lower back in female patients with lumbar radiculopathy in their 40s.