Article

Manual therapists typically advocate the need for a detailed clinical
examination to decide which vertebral level should be manipulated in patients
with low back pain. However, it is unclear whether spinal manipulation needs to
be specific to a vertebral level. The purpose of this study was to
analyze the immediate effects of a single, region-specific spinal manipulation
defined during the clinical examination versus a single non-region-specific
spinal manipulation (applied on an upper thoracic vertebra) in patients with
chronic nonspecific low back pain for the outcome measures of pain intensity and
pressure pain threshold at the time of the assessment. DESIGN: This was a 2-arm,
prospectively registered, randomized controlled trial with a blinded assessor.
SETTING: The study was conducted in an outpatient physical therapy clinic in
Brazil. PATIENTS: The study participants were 148 patients with chronic
nonspecific low back pain (with pain duration of at least 12 weeks).
RANDOMIZATION: The randomization schedule was generated by an independent
statistician and was concealed by using consecutively numbered, sealed, opaque
envelopes. INTERVENTIONS: A single high-velocity manipulation was administered to
the upper thoracic region of the participants allocated to the
non-region-specific manipulation group and to the painful lumbar levels of the
participants allocated to the region-specific manipulation group. MEASUREMENTS:
Pain intensity was measured by a 0 to 10 numeric pain rating scale. Pressure pain
threshold was measured using a pressure algometer. LIMITATIONS: It was not
possible to blind the therapist and participants. RESULTS: A total of 148
patients participated in the study (74 in each group).
There was no loss to
follow-up. Both groups improved in terms of immediate decrease of pain intensity;
however, no between-group differences were observed. The between-group difference
for pain intensity and pressure pain threshold were 0.50 points (95% confidence
interval=-0.10 to 1.10) and -1.78 points (95% confidence interval=-6.40 to 2.82),
respectively. No adverse reactions were observed. CONCLUSION: The immediate
changes in pain intensity and pressure pain threshold after a single
high-velocity manipulation do not differ by region-specific versus
non-region-specific manipulation techniques in patients with chronic low back pain.

Langue : ANGLAIS