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Robert J. Fluegel, PT, COMT
MAPS Faculty, Fellow in Training, MAPS Orthopedic Manual Therapy Fellowship

Chris R. Showalter, PT, OCS, COMT, FAAOMPT, Fellowship Program Director

Mobilization combined with Stabilization is SUPERIOR compared to Stabilization alone in Non-Specific Mechanical Neck Pain (NSMNP)

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Maitland Lumbar UPA Joint Mobilizations Significantly Improves SLR Compared to Both Static Stretching and Control Groups

April 02, 2012


Chris Showalter PT, OCS, COMT, FAAOMPT

MAPS Clinical Director

Maitland Lumbar UPA Joint Mobilizations Significantly Improves SLR Compared to Both Static Stretching and Control Groups

A fascinating, and very promising area of study, is our developing understanding of how various manual interventions may moderate aspects of the nervous system.  Most clinicians are familiar with these “Neurophysiological Effectsâ€?.  Valuable research is coming to the fore in the areas of mechanosensitivity, pain modulation, and the effects of mobilization on spinal hyeprexcitability, to name but a few.   

The purpose of this Research Commentary is to introduce a well-designed and executed 2011 Randomized Controlled Trial (RCT) by Szlezak AM et. al. (PubMed weblink below).  The Szlezak RCT showed that Maitland Grade III, Unilateral Postero Anterior (UPA) joint mobilizations applied to the Lumbar spine, significantly improved ispilateral SLR ROM (8.5°, p < 0.001), compared to both a static stretching group and a control group.

The 2011 Szlezak study involved 36 asymptomatic, 18-65 year old males and females (Calculated Effect size 0.25 and Power 80%) who were randomized into 3 groups:

  • 12 Control Subjects--These patients lay supine for 3 minutes monitored by a researcher.


  • 12 Static Stretch subjects--These patients received 3 minutes of static stretch at researcher-perceived R1.


  • 12 Mobilization Subjects—These patients received 30 seconds of 2 Hz, Grade III UPA T12/L1 through L5/S1…6 levels (total of 3 minutes).

The researchers used a novel bracing device during SLR measurements to control joint positions of full available knee extension and ankle plantar grade.  Measurements of hip flexion were taken using a bubble inclinometer fixed to the bracing device.

Szlezak AM et al, demonstrated that Lumbar spine mobilization significantly improves ispilateral SLR and concluded that this most likely reflects a change in posterior chain neurodynamics.  This conclusion builds on the prior work on nervous system mechanosensitivity in the lower limb by Boyd et al (2009) and the effect of Lumbar UPA mobilizations on the peripheral nervous system by Perry and Green (2008).   Please see these PubMed references for these articles below.

The effects cited by the Szlezak, et. al. study are not unique to the Lumbar spine.  Sterling et al (2001) showed that Grade III Cervical UPA mobilization has concurrent effects on pain, sympathetic nervous system activity and motor activity.  These effects are not unique to UPAs.  Sterling et al (2010) showed that cervical lateral glides may be effective in reducing spinal hyperexcitability in chronic WAD.

Next time you are mobilizing a spinal segment or peripheral joint, by all means, give due consideration to the effect your technique may be having upon the specific target tissues under your hands.  But, don’t stop there.  You should also think more globally and consider the potential effect your intervention may be having upon the patient’s nervous system and pain perception.



Chris R Showalter

© Chris R. Showalter and Maitland Australian Physiotherapy Seminars

Not to be reproduced, copied or retransmitted in any manner without author’s express written permission

Directing others to the MAPS website ( is permissible.

Where to find the Articles


Szlezak AM, Georgilopoulos P, Bullock-Saxton JE, Steele MC. “The immediate effect of unilateral lumbar Z-joint mobilisation on posterior chain neurodynamics: a randomised controlled study,� Man Ther. 2011;16(6):609–613.


Boyd BS, Wanek L, Gray AT, Topp KS. “Mechanosensitivity of the lower extremity nervous system during straight-leg raise neurodynamic testing in healthy individuals,� J Orthop Sports Phys Ther. 2009;39(11):780–790.


Perry J, and Green A. “An investigation into the effects of a unilaterally applied lumbar mobilisation technique on peripheral sympathetic nervous system activity in the lower limbs,� Man Ther. 2008 Dec;13(6):492-9.


Sterling M, Jull G, Wright A, “Cervical mobilisation: concurrent effects on   pain, sympathetic nervous system activity and motor activity,â€? Man Ther. 2001 May;6(2):72-81.


Sterling M, Pedler A, Chan C, Puglisi M, Vuvan V, Vicenzino B, “Cervical lateral  glide increases nociceptive flexion reflex threshold but not pressure or thermal pain thresholds in chronic whiplash associated disorders: A pilot randomised controlled trial,â€? Man Ther. 2010 Apr;15(2):149-53.

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