Comparison between high-velocity low-amplitude manipulation and muscle energy technique on pain and trunk neuromuscular postural control in male workers with chronic low back pain: A randomised crossover trial

Abstract

Background: A therapeutic recommendation for restoring function in individuals with chronic low back pain (CLBP) is manual therapy through manipulative spinal or muscle energy techniques.Objectives: To compare the effectiveness of two osteopathic manipulative techniques on clinical low back symptoms and trunk neuromuscular postural control in male workers with CLBP.Method: Ten male workers with CLBP were randomly allocated to two groups: high-velocity low-amplitude (HVLA) manipulation or muscle energy techniques (MET). Each group received one therapy per week for both techniques during 7 weeks of treatment. Pain and function were measured by using the Numeric Pain-Rating Scale, the McGill Pain Questionnaire and the Roland Morris Disability Questionnaire. The lumbar flexibility was assessed by Modified Schober Test. Electromyography (EMG) and force platform measurements were used for evaluation of trunk muscular activation and postural balance, respectively at three different times: baseline, post intervention, and 15 days later.Results: Both techniques were effective (p 0.01) in reducing pain with large clinical differences (-1.8 to -2.8) across immediate and after 15 days. However, no significant effect between groups and times was found for other variables, namely neuromuscular activation and postural balance measures.Conclusion: Both techniques (HVLA thrust manipulation and MET) were effective in reducing back pain immediately and 15 days later. Neither technique changed the trunk neuromuscular activation patterns nor postural balance in male workers with LBP.Clinical implications: These results may facilitate clinical decision-making for CLBP management in physiotherapy programs.

The relationships between spinal amplitude of movement, pain and disability in low back pain: A systematic review and meta‐analysis

“…For the relationship between change in spinal amplitude and change in disability, based on longitudinal data, 33 studies with 2437 participants were included in the meta‐analysis (Alves et al, 2020; Anderson et al, 2013; Ansari et al, 2014; Bazzaz‐Yamchi et al, 2021; Caporaso et al, 2012; de Brito Macedo et al, 2019; Ekedahl et al, 2012; Garcia et al, 2013; George et al, 2006; Grosdent et al, 2023; Hrkać et al, 2022; Hurri et al, 1995; Joshi et al, 2021; Kiran et al, 2017; Larivière et al, 2022; Lenoir dit Caron et al, 2022; Loisel et al, 1998; Mannion et al, 2012; Martin et al, 1986; Mellin et al, 1989; Mieritz et al, 2014; Nemcić et al, 2013; Nordstoga et al, 2019; Ozkaraoglu et al, 2020; Sakulsriprasert et al, 2011; Satpute et al, 2019; Shahvarpour et al, 2017; Silveira et al, 2021; Steele et al, 2013; Sturion et al, 2020; Sullivan et al, 2000; Takinacı et al, 2019; Taşpınar et al, 2023; Vowles et al, 2007). The pooled coefficient was −0.23 [95%CI −0.31 to −0.15], indicating that an increase in spinal amplitude was associated with a decrease in disability (Figure 3).…”

“…Thirty‐eight studies, totaling 2172 participants, were included in the meta‐analysis about the longitudinal relationship between the change in spinal amplitude and the change in pain intensity (Alves et al, 2020; Anderson et al, 2013; Ansari et al, 2014; Bazzaz‐Yamchi et al, 2021; Beladev & Masharawi, 2011; Boucher et al, 2018; Christe et al, 2022; de Brito Macedo et al, 2019; Elnaggar et al, 1991; Ferguson, 1998; Garcia et al, 2013; George et al, 2006; Grosdent et al, 2023; Hrkać et al, 2022; Joshi et al, 2021; Kim et al, 2015; Kiran et al, 2017; Larivière et al, 2022; Lenoir dit Caron et al, 2022; Louw et al, 2015; Louw, Farrell, et al, 2017; Louw, Zimney, et al, 2017; Martin et al, 1986; Masharawi & Nadaf, 2013; McCracken et al, 2002; Mieritz et al, 2014; Nemcić et al, 2013; Nordstoga et al, 2019; Ozkaraoglu et al, 2020; Sakulsriprasert et al, 2011; Satpute et al, 2019; Shahvarpour et al, 2017; Silveira et al, 2021; Steele et al, 2013; Sturion et al, 2020; Takinacı et al, 2019; Taşpınar et al, 2023). The pooled coefficient was −0.25 [95% CI: −0.33 to −0.17] indicating that an increase in spinal amplitude was associated with a decrease in pain intensity (Figure 5).…”

The effectiveness of dry needling in patients with chronic low back pain: a prospective, randomized, single-blinded study

“…Functional efficiency was assessed with the Oswestry Disability Index (ODI) 18 . The motion range of the lower spine was measured with the Schober test 19 . In both groups, measures were taken before and immediately after treatment.…”