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MOBILIZATION VERSUS
MUSCLE ENERGY
TECHNIQUES, A
LITERATURE REVIEW

MATTHEW MALONE
MARCH 19TH, 2023
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Unspecified low-back pain is one of the major causes of disability in adult populations

worldwide.1The manual therapy course we have been participating in has introduced various

evidence-based treatments for improving patient complaints of back pain/dysfunction. Two of

the most common manual interventions for low-back pain are muscle energy techniques (MET)

and mobilization. With several options to choose from, it begs the question “which is the best?”.

More precisely, in adults with low-back pain, how effective are MET’s compared to mobilization

in decreasing pain/disability? The goal of this literature review is to investigate current research

on the topic, and determine an answer to the above stated question.

A search of the literature revealed three articles that will be useful in making a determination.

The first to be discussed directly compared Maitland mobilization techniques versus MET’s in a

randomized controlled trial. 60 participants were randomly assigned into two groups with similar

demographics.2 Inclusion criteria was extensive, ensuring each group was similar. One group

was treated with MET’s while another received Maitland mobilizations; both groups were

additionally given lumbopelvic stability exercises to perform. Outcome variables of interest were

pain measured using a visual analog scale, and disability measured using the Modified Oswestry

Disability Index.2 Measures were assessed on the initial day of treatment and after one month of

treatment. Both intra- and inter-group analysis was performed using t-tests with a p-value set at

<.05.2

Results from both intra-group comparisons demonstrated significant differences in pre/post-test

scores lowering both perception of pain and disability. Inter-group analysis revealed insignificant
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differences in the impact of the treatment methods. This study demonstrated that both

mobilization and MET’s can be effective methods in treating low-back pain.

This article graded at a level of 8/10 using the PEDro scale.3This is considered a “good” score;

however, several factors were present that could misrepresent the conclusions of the study. The

participants could not be blinded to the treatment they received, and this could influence their

responses based on their individual treatment beliefs. Additionally, there is no recorded

frequency of treatment. Outcomes were measured thirty days apart, but it is unclear how often

intervention was applied. Finally, the addition of lumbopelvic stabilization exercises adds a

confounding variable. With no significant between groups differences, it could be hypothesized

that the only treatment having an effect were the stabilization exercises.

The next article examined the impacts of both treatments used together versus a sham treatment

in patients with chronic low back pain. The study took 455 participants and randomly divided

them into four subgroups: manual therapy (MT) + ultrasound (US), MT + sham US, sham MT +

US, and sham MT + sham US.4 A baseline visual analog pain scale was used to measure baseline

pain, and patients were classified to high or low severity (randomization not affected). Patients

received fifteen-minute treatment sessions six times over the course of eight weeks, consisting of

mobilization, MET’s, and several other manual techniques. Outcome measures of pain reduction

were tiered, with a fifty percent reduction being labelled substantial.4 The Roland and Morris

disability questionnaire measured back-specific functioning.

In the lower-severity back pain group, there was not a significant difference in the number of

patients who reported substantial change between the MT and sham MT groups.4 In high-
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severity cases, the difference between MT and sham MT for substantial improvement was

significant with a large effect size. This study demonstrated that the use of mobilization in

concert with MET’s can be highly effective in managing severe chronic low-back pain.

This article scored an 8/10 on the PEDro scale.3 Participants were randomly assigned, were

blinded to their treatment category, and group demographics were similar. Unlike the previous

study, volume of treatment was adequately described. Limitations described by this study

revolved around the idea that because many different techniques were used in the MT approach,

it can be hard to define if an individual technique was the causation of improvement.4

The third article to be discussed compared mobilization and MET’s to a sham treatment to

examine the efficacy of mobilization, and I felt it reasonable to include to shed light on the

justification of mobilization/MET as a treatment option. Patients were selected to be suffering

from non-specific low back pain for less than 26 weeks, and strict exclusion criteria were

explained to eliminate specific pathology.5 Patients were randomly assigned into either MT or

sham MT groups, both groups also receiving active exercise in addition to treatment. MT

treatments utilized Maitland mobilizations, MET’s and thrust manipulations for five to ten

minutes of each treatment session, followed by active exercise.5

This study was focused on immediate pain relief as well as pain/disability over time. A visual

analog scale for pain rating was used immediately before/after each MT/sham-MT session. In

addition, VAS was measured prior to initiation, after the eight sessions, and at three- and six-

month follow-ups; Disability was measured using the Oswestry Disability Index.5 This study
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concluded that the MT group reported more immediate pain-relief post session than the sham-

MT group, and also elicited less disability and pain after completion of the entire program.5

This article scores an 8/10 on the PEDro scale.3 This is score is considered good, although not

without its flaws. There was a noted drop of three patients indicated throughout the course of the

study, and intention-to-treat analysis was not specified in the statistics. It was also stated in the

article that the necessary number of participants for a statistical power >.8 was 52, and that that

number could not be reached due to difficulty recruiting/financial restrictions.5

As a result of this literature review, I have come to the conclusion that the question I set out to

answer doesn’t necessarily need to be answered. MET’s are proven to be an effective way to

treat low-back pain.2,4 Mobilization is proven to be an effective way to treat low-back pain.2,4,5 In

high-severity cases, using both treatments in conjunction can yield significant improvements.4 In

clinical practice, it is important to have a tool bag that doesn’t just have a hammer in it. You

must be willing to try several methods of treatment, and apply the treatment that invokes the

optimal response on a patient-to-patient basis.

References

1. Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude
Publica. 2015;49:1. doi:10.1590/S0034-8910.2015049005874
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2. Zaidi F, Ahmed I. Effectiveness of muscle energy technique as compared to Maitland mobilisation for the
treatment of chronic sacroiliac joint dysfunction. J Pak Med Assoc. 2020;70(10):1693-1697.
doi:10.5455/JPMA.43722

3. Pedro scale. PEDro. https://pedro.org.au/english/resources/pedro-scale/. Published September 9, 2020.

Accessed March 19, 2023.
4. Licciardone JC, Kearns CM, Minotti DE. Outcomes of osteopathic manual treatment for chronic low back
pain according to baseline pain severity: results from the OSTEOPATHIC Trial. Man Ther.
2013;18(6):533-540. doi:10.1016/j.math.2013.05.006
5. Balthazard P, de Goumoens P, Rivier G, Demeulenaere P, Ballabeni P, Dériaz O. Manual therapy followed
by specific active exercises versus a placebo followed by specific active exercises on the improvement of
functional disability in patients with chronic non specific low back pain: a randomized controlled
trial. BMC Musculoskelet Disord. 2012;13:162. Published 2012 Aug 28. doi:10.1186/1471-2474-13-162