Comparing targeted thrust manipulation with general thrust manipulation in patients with low back pain. A general approach is as effective as a specific one. A randomised controlled trial

Abstract

BackgroundSpinal manipulation is commonly used to treat back pain. The application of spinal manipulation has traditionally involved an element of targeting the technique to a level of the spine where the proposed movement dysfunction is sited. We evaluated the effects of a targeted manipulative thrust versus a thrust applied generally to the lumbar region.MethodsA randomised controlled clinical trial in patients with low back pain following CONSORT (Consolidated Standards of Reporting Trials) guidelines. Sixty subjects were randomly allocated to two groups: one group received a targeted manipulative thrust (n=29) and the other a general manipulation thrust (GT) (n=31) to the lumbar spine. Thrust was either localised to a clinician-defined symptomatic spinal level or an equal force was applied through the whole lumbosacral region. We measured pressure-pain thresholds (PPTs) using algometry and muscle activity (magnitude of stretch reflex) via surface electromyography. Numerical ratings of pain and Oswestry Disability Index scores were collected.ResultsRepeated measures of analysis of covariance revealed no between-group differences in self-reported pain or PPT for any of the muscles studied.SummaryA GT procedure—applied without any specific targeting—was as effective in reducing participants’ pain scores as targeted approaches.Trial registration number ISRCTN11994230.

Manual Therapy: Art or Science?

“…Indeed, sacroiliac [15], lumbar [15,86], thoracic [86], and cervical [87] manipulation techniques have been shown to produce clinical and biomechanical effects on different vertebral levels, which are therefore not specific to the target segment and lead the practitioner to produce unpredictable vertebral movements [88]. This data is confirmed by clinical studies that have shown an overlap between the therapeutic effect of manipulations theoretically directed at a single vertebral level and "global" manipulation techniques involving the lumbar spine of subjects with low back pain [89].…”

The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review

“…All but three authors 25 – 27 reported if there were any conflicts of interest, and four reported that they received funding 23 , 24 , 31 , 32 . We contacted the authors of three articles 30 , 33 , 34 with insufficient data to estimate effect sizes. We received one response that allowed us to include that article 30 .…”

Manual Therapy versus Localisation (Tactile, Sensory Training) in Patients with Non-Specific Neck Pain: A Randomised Clinical Pilot Trial

“…Several manual therapy studies that have shown equivocal reductions in spinal pain perception in groups receiving localised touch, combined with a localised kinetic force applied to a specific, intervertebral level when compared to a group receiving general, nonlocalised movement of a region of the spine. However, none of the studies included an element of localisation training of sensory attention to the location of the touch [53][54][55]. This has led some authors to question the need to target localised points, within painful regions of the spine, for the application of forces inducing passive movement [55,56].…”

“…However, none of the studies included an element of localisation training of sensory attention to the location of the touch [53][54][55]. This has led some authors to question the need to target localised points, within painful regions of the spine, for the application of forces inducing passive movement [55,56]. Thus, the application of localised touch and local movement to the spine of a recipient, not focusing their attention on a localised tactile stimulation, is not superior to non-specific regional touch and regional movement.…”