this study will be conducted to investigate the effect of hip extension mobilization on lumber disability, pain and flexion range of motion in patients with spondylolisthesis
Chronic female Patients diagnosed as grade 1 lumbar degenerative spondylolisthesis (anterolisthesis) referred from Orthopedists was confirmed by lumbosacral x-ray
Patients age ranged from 40 to 60 years.
BMI(25:35)
Ambulant patient with or without cane.
Osteoporosis.
Pregnancy.
Signs consistent with nerve root compression (reproduction of low-back or leg pain with a straight leg raise at less than 45°, muscle weakness involving a major muscle group of the lower extremity, diminished lower extremity muscle stretch reflex, or diminished or absent sensation to pinprick in any lower extremity dermatome).
General tumors, spinal tumor, fracture, cauda equina syndrome, and previous surgery.
Parallel
hip extension mobilization
Other interventionthe patients will receive hip extension mobilization to increase hip extension range of motion; the therapist applies an anterior glide mobilization-usually with the patient in a prone position. The patient is positioned in prone at the edge of the table. The hip is then flexed, abducted, and externally rotated into position as tolerated by the patient, and the foot is placed next to the contralateral knee. Impart anterior mobilization through the greater trochanter. The therapist applies a grade IV mobilization in a posterior to anterior direction to target the anterior hip. The mobilizing hand applies a downward ward force through an extended elbow; body weight exerts the force+ cinentional treatment
conventional treatment
Other interventionEach subject will be given treatment of 30-40 minute session of William flexion exercises. The seven variations of Williams's exercises include (Pelvic tilt, single knee to chest, double knee to chest, half sit-up, hamstring stretch, hip flexor stretches, and squat). in additionn, The TENS electrodes are typically placed bilaterally along the lumbar paraspinal region directly over the painful area. The frequency of the output was set at 4 to 8 Hz. Continuous type used.
low back disability
Arabic version of Roland Morris Disability will be used to assess low back disability. it is a valid, reliable 24-item tool used to assess physical disability in patients with low back pain (LBP). It has been culturally adapted to Modern Standard Arabic, with a score ranging from 0 to 24, where higher scores indicate greater functional disability.
pain intensity
The visual analogie scale will be used to assess pain intensity. it is a one-dimensional instrument used to assess subjective pain intensity. It comprises a 10-cm (100-mm) line; with 0 refer to no pain while 100mm refer to extreme pain.
lumbar flexion range of motion
The BROM device will be used for lumbar flexion ROM.
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