Comparing 3 Manual Therapy Techniques for LBP

Reference:Cleland JA et al Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: a randomized clinical trial. Spine (Phila Pa 1976). 2009 Dec 1;34(25):2720-9.

Patients with LBP who met the Clinical Prediction Rule (CPR) for lumbar manipulation were randomly allocated to receive one of three manual therapy techniques for 2 sessions followed by 3 additional exercise sessions.

The three manual techniques were

1) General lumbar rotation manipulation in supine

2) Specific lumbar rotation manipulation in side lying

3) Two sets of PA mobilizations over L4 and L5 spinous processes for 60 seconds

Conclusion: The patients who received either of the manipulation techniques had the same benefits at 1 week, 4 weeks and at 6 months follow-up. However those who received the PA mobs had significantly less improvements when compared to those who received the manipulations.

Personal Comments: With the greatest respect to the father of manual therapy (G. Maitland, PT) I have yet to ever use straight PAs on patients with LBP. I probably used them for a few weeks after graduation 23 years ago, and then I abandoned them after not seeing results.

For the majority of my PT career I have now mobilized only one way: mobilizations with movement (MWM) and have abandoned any static PAs in prone. My anecdotal experience is that I consistently get better results with the correct MWM than I do with manipulations. I am still awaiting a study to prove me right or wrong!

Posted on: July 03, 2015


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