Does Hearing a POP During a Manipulation Technique Influence Outcome?
Reference:Flynn TW, et al. The audible pop from high-velocity thrust manipulation and outcome in individuals with low back pain. J Manipulative Physiol Ther. 2006 Jan;29(1):40-5.
This really unique and interesting study set out to see if there was a relationship between an audible pop with spinal manipulation and improvement in pain and function in patients with low back pain.
Patients with non-radicular LBP were managed in physical therapy twice the first week, then once a week for the next 3 weeks, for a total of only 5 sessions.
A single lumbo-pelvic manipulative technique was used during the first two sessions. Therapists recorded whether the patient or therapist heard an audible pop.
Study Conclusion: This study supports the hypothesis that an audible pop may not relate to improved outcomes from high-velocity thrusts for patients with LBP at either an immediate or longer-term follow-up.
Clinical Relevance: There can be no question that all manual therapy interventions have some degree of placebo effects. Based on that, many have long claimed that hearing the pop also has tremendous placebo effects, which may be the greatest benefit of manipulation. Interestingly, this study seems to contradict that theory!
Personal Comment:Considering the incredible evidence supporting Physical Therapy manipulation, every PT involved in the management of LBP should be confident in providing lumbo-pelvic manip techniques.
Posted on: June 22, 2006
Categories: Lumbar Spine