To Compare the Effect of Total Motion Release Technique versus Lumbar Sustained Natural Apophyseal Glide (SNAGS) in Patient with Chronic Low Back Pain

INTRODUCTION: The most common condition people experience in their lifetime is low back discomfort. Based on years lived with disability (YLD) measures, non-specific low back pain has been classified as the most prevalent cause of disability. It is the second most common source of reported pain after headaches. The age-related degenerative changes that occur in people between the ages of 30 to 40 years increase their risk of developing low back pain. Total Motion Release (TMR) Techniqueis one of the manual therapy technique. Researchers have reported that the therapeutic application of TMR has decreased pain, increased function, and restored range of motion (ROM) in the knee, low back, and shoulder, despite the fact that TMR has not been thoroughly researched in patient care. It has also been discovered that TMR application restores non-painful ROM limits. The application of Mulligan’sMobilisation with Movement Technique (MWM) for musculoskeletal disorders, including low back pain, is becoming more and more common. One of the most significant MWM techniques, known as "sustained natural apophyseal glide" (SNAG) was invented by Brian Mulligan. An accessory passive glide is applied to the lumbar vertebrae during SNAG as the patient concurrently engages in an active movement. Both structural and functional deterioration are its symptoms. Positional defect is improved and range of motion is increased by using passive overpressure in conjunction with Brian Mulligan’s Mobilization with Movement (MWM).

**NEED OF THE STUDY:**There was only single pilot study being done on studying the effects of Total Motion Release on Non - Specific low back pain where some specific postures were been practiced by the patients with LBP. We are aware that Lumbar SNAGS is also proven effective in alleviating LBP. For its practice, a therapist is required. So we would like to compare Lumbar SNAGS with this new concept i.e. TMR and would like to observe which one is more effective. If TMR found more effective it can be easily practiced by the patients and can be prescribed as home exercise program to have the extended effects/ reduced symptoms.

**METHODOLOGY:**Participants will be allocated randomly through computer generated random number table in two groups: Total Motion Release Techniquewith Conventional Therapy -group (A) and Lumbar SNAGS with Conventional Therapy - group (B). Before starting the intervention, all the participants’ baseline data will be obtained as per case report sheet. Both the groups will be assessed Before Intervention using valid Outcome Measures likeNumerical pain rating scale (NPRS), Range of Motion (Assessed by the Modified Schober’s Test), Oswestry disability Index (ODI) [Annexure (4.7) (English) and Annexure (4.7) (Gujarati)].To check the status of pain, Range of Motion and Functional ability in patients with Low Back Pain. Then, 10 sessions * 2 weeks Intervention will be given to participants. After completion of 10 sessions patients will be re-assessed by using valid Outcome Measures like Numerical pain rating scale (NPRS), Range of Motion (Assessed by the Modified Schober’s Test), Oswestry disability Index (ODI).