Is Lumbar Manipulation Really Superior to Other Manual Therapies?

Reference:Cook C, et al. Early use of thrust manipulation versus non-thrust manipulation: A randomized clinical trial. Man Ther. 2013Jun;18(3):191-8.

Many clinicians swear that compared to doing non-thrust manual techniques, their patients get faster and better outcomes with manipulations. Are they biased or is their belief really true?

This recent RCT investigated the comparative effectiveness of early use of thrust/manipulation and non-thrust/mobilizations in patients with mechanical low back pain (LBP). This was a first study of its kind where it was a pragmatic versus a prescriptive trial.

Prescriptive means prior to the study they tell the involved PTs that they must do either technique A or technique B exactly 3 sets of 10 and so forth for all treatments. This is to standardize treatments, which makes for a good study but poor clinical replication and realism. Pragmatic trials on the other hand allow the PT the clinical decision making process to choose the best treatment for the specific patient (which is realistic).

In a Nutshell: The study found no differences in outcomes of pain, disability, or number of required treatments between the patients who received 2 sessions of early lumbar manips versus those who received other forms of manual therapy.

Personal Comment: The patients in this study had on average 9 months of low back pain. In sub-acute or persistent pain cases I choose non-thrust techniques. However, I may be wrong, but when I have a patient with less than 3 weeks of mechanical back pain, I must admit I’m tempted to do a thrust manipulation plus re-assurance and a really good home exercise program.

Posted on: July 05, 2013

Categories: Lumbar Spine

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