Low back pain (LBP) is increasingly becoming one of the main health concerns nowadays. It
affects daily life and work routine and leads to medical consultations. The prevalence of
NSLBP is approximately 10 to 25% in young and middle-aged individuals. Even though
degenerative changes are minimal in this age group, more physical activities consequently
make this group vulnerable to various physical strains. Approximately 10% of LBP cases have
an identifiable pathology, while the remaining 90% are non-specific LBP (NSLBP), reflecting
LBP of unknown underlying pathology, characterized by pain, muscle tension, and stiffness
between 12th rib and inferior gluteal fold. Based on duration, LBP can be categorized as
acute (less than six weeks), sub-acute (six to twelve weeks), and chronic (more than twelve
weeks). Common symptom is the pain that gets worse with activity and relieved by rest. There
are different methods for LBP treatment like surgery, oral medication, injection at lumbar
region, psychotherapy, chiropractic and physiotherapy. Physiotherapy modalities and
techniques like electrotherapy, low level laser, ultrasound, massage, shortwave, traction,
superficial heat, spinal manipulation and exercise therapy are used to treat such cases.
Extracorporeal Shock Wave Therapy (ESWT) has emerged as a popular tool for treatment of
musculoskeletal disorders such as lateral epicondylitis, painful shoulder syndrome and
plantar fasciitis. The two primary types of shock waves are the Focused Extracorporeal Shock
Wave (fESW) and the Radial Extracorporeal Shock Wave (rESW). They differ in terms of the
manner and extent of the acoustic energy propagation, the shape of the beam and its physical
properties. Maitland mobilization techniques are thought to benefit patients with lumbar
mechanical pain through the stimulation of joint mechanoreceptors.
A systematic review and meta-analysis of RCTS was conducted in 2020 to check the
effectiveness and safety of extracorporeal shockwave treatment on low back pain. Multiple
electronic databases including PubMed, Embase, Cochrane's library, China National Knowledge
Infrastructure (CNKI), and Wan Fang Data were searched until December, 2019 to identify
studies assessing the effectiveness and safety of EPSW for LBP. The main outcome was pain
intensity which was measured using visual analogue scale (VAS) and numeric pain rating scale
(NPRS).Functional status, quality of life and psychological outcomes were also measured using
oswestry disability index (ODI). Findings of all these studies concluded that the use of
focused ESWT is effective in alleviating pain and improving general functional state of
patients with low back pain. The effectiveness of Maitland spinal mobilization therapy in the
treatment of non-specific low back pain. It was a prospective study that involved ninety (90)
subjects who completed the recommended four-week program. All subjects were given spinal
mobilization therapy using Maitland method. The conclusions of this study indicated that
manual therapy is a consideration in treatment of non-specific LBP and as an alternative to
conventional treatment methods.
The effects of shockwave therapy and Maitland lumbar mobilizations have been seen to be the
effective approaches in the treatment of mechanical or non-specific low back pain. But these
treatment approaches have seen independently in treating low back pain. But there is no
literature available that compares the effect of both techniques. So to see the comparative
effects of these two techniques will be the main goal of this study.