Effects of Manual Therapy (McKenzie Approach) Versus Therapeutic Exercise (Core Strength) for Lower Back Pain in Fast Bowlers: A Randomized Controlled Trial
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Abstract
Background: Fast bowling repeatedly exposes the lumbar spine to extension, rotation, side flexion, impact and high cumulative training loads. Both the McKenzie Approach and core-strength therapeutic exercise are used for mechanical or non-specific lower back pain, but direct comparative evidence in fast bowlers is limited. Objective: To compare the short-term effects of McKenzie-based manual therapy with progressive core-strength therapeutic exercise on pain, disability and patient-specific function in fast bowlers with lower back pain. Methods: Thirty male fast bowlers were randomly allocated to Group A (McKenzie Approach / Manual Therapy, n=15) or Group B (Core Strength / Therapeutic Exercise, n=15) for 8 weeks. Pain was measured with the Visual Analogue Scale (VAS), disability with the Oswestry Low Back Pain Disability Questionnaire (OLBPDQ), function with the Patient-Specific Functional Scale (PSFS), and perceived recovery with Global Perceived Effect (GPE). Paired t-tests assessed within-group change, independent-samples t-tests compared groups, and chi-square tests were used for categorical variables. Results: Both groups improved significantly in VAS, OLBPDQ and PSFS (all within-group p<0.001). VAS decreased from 4.60 ± 1.06 to 2.40 ± 0.63 in Group A and from 4.66 ± 0.72 to 3.33 ± 0.62 in Group B. VAS improvement was greater in Group A (2.20 ± 0.67 vs 1.33 ± 0.72; p=0.002; d=1.25), as was OLBPDQ improvement (3.38 ± 1.19 vs 1.18 ± 0.65; p<0.001; d=2.29). PSFS improvement was substantial in both groups but not significantly different (10.56 ± 3.46 vs 9.93 ± 4.44; p=0.669). Group B attended more sessions and had higher session attendance, while adverse events were uncommon and mild. Conclusion: Both interventions were effective, but McKenzie-based care produced greater short-term reduction in pain and disability. Core-strength training provided meaningful functional gains and remains important for lumbopelvic control and return-to-bowling conditioning.
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