Mulligan Bent Leg Raise Technique

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Description

The Mulligan bent leg raise (BLR) technique is used for improving range of straight leg raise (SLR) in subjects with LBP and/or referred thigh pain (Mulligan, 1999) and also in order to improve flexibility of hamstring in clients with tight hamstrings. The intention of this technique is to restore normal mobility and reduce LBP and physical impairment. It stretches the lower extremity muscles in combination of hamstring, adductors and rotators.

Indication

Low Back Pain, Hamstring tightness & to stretch Thoraco lumbar fascia.

Clinical Application

It has been suggested that improving SLR mobility reduces the degree of impairment in LBP (Blunt et al., 1997; Hall et al., 2001; Hanten and Chandler, 1994).

The SLR test has biomechanical effects on pelvis movement, on lumbosacral neural structures (Breig and Troup, 1979; Butler, 1991) and hamstring muscles (Burns and Mierau, 1997). Hence, it is important when investigating SLR to evaluate the component movements that include hip flexion and posterior pelvic rotation (Hall et al., 2001).

The BLR technique (Mulligan, 1999) consists of three repetitions of pain-free, 5 s, isometric contraction of the hamstrings, performed in five progressively greater positions of hip flexion.

Dixon and Keating (2000) suggest that improvement in range of SLR must be greater than 6 degree to state that a real change in SLR range has occurred. Consequently, the change in range produced by the BLR is of clinical relevance only 24 h after the intervention.

Key Evidence

A number of studies have investigated techniques to improve range of SLR in asymptomatic samples(Clark et al., 1999; Hall et al., 2001; Sullivan et al., 1992; Worrell et al., 1994). The improvement in range determined in these studies ranged from 81 to 131. Only two other studies, known to us, have investigated the effect of treatment interventions on SLR range in subjects with LBP (Beyerlein et al., 2002; Meszaros et al., 2000). Improvement in SLR range was 111 (Beyerlein et al., 2002) and 81 (Meszaros et al., 2000). However, these studies did not incorporate a placebo or control group. That was Toby Hall who underwent a preliminary randomized trial of immediate effects after a single intervention of Mulligan bent leg raise technique.

Improvement of SLR range because of the BLR technique might be due to mobilization of the painful, sensitized nerve tissues, similar to the ‘‘slider’’ effects described by Butler (1991) and Elvey and Hall (1997). Another beneficial effect of the BLR technique might be a change in stretch tolerance of the hamstrings. Goeken and Hof (1994) demonstrated that the increased range of SLR, following stretching, is mediated via an increase in hip flexion & pelvic rotation as well as hamstring length, and not related to increased hamstring viscoelastic properties.

An assumption can be made that the BLR technique triggers neurophysiological responses influencing the muscle stretch tolerance. In the study by Toby Hall there was increased posterior pelvic rotation. An increase in hamstring extensibility might reduce stress on painful lumbar tissues and hence allow an increase in posterior pelvic rotation resulting in greater lumbar flexion.

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