Low Back Pain Patients Respond to Thrust Manipulation Techniques

For some time now, physical therapists have been trying to find better ways to treat patients with low back pain. By better we mean more effective treatment with successful results. And successful refers to getting relief from pain that doesn't come back.

A group of well-known therapists started by developing a clinical prediction rule (CPR). The rule is used to predict which patients are most likely to have a good response to treatment. This group of therapists has developed a clinical prediction rule that has been tested and found to be valid and reliable for treating low back pain using one particular thrust manipulation technique.

Once that was settled, they turned their attention to whether the same clinical prediction rule could be used for other types of manual therapy. Manual therapy refers to a hands-on treatment given by physical therapists to reduce back pain and improve function.

Manual therapy techniques vary but include thrust and nonthrust manipulation of the spinal joints. The difference between thrust and nonthrust manipulation is the speed or velocity of the force directed through the joint.

The theory behind the use of joint manipulation is changing. For a long time, it was believed that the manipulation changed the alignment of the spine and spinal joints. Once the joint was balanced with everything lined up nicely, movement is restored and stiffness reduced. Therapists were very careful to apply just the right amount of force in just the right direction to achieve the desired results.

But scientists have shed some new light on how and why manipulation might work. And it may have more to do with the effects on mechanoreceptors and motor neuron excitability than on spinal alignment. Mechanoreceptors are tiny antenna in the joint that detect change in motion. Once the motor nerves have been charged up (excited) by injury or trauma, they don't calm down on their own. That's what motor neuron excitability refers to.

If manual therapy can alter mechanoreceptor responses, then maybe any technique used (thrust or nonthrust) will have the same positive effects. Or maybe there are subgroups of patients with low back pain who would respond to one technique better than another. To find out, these therapists treated 112 low back pain patients with one of three manual therapy techniques.

Each patient received two manual therapy treatment sessions with his or her assigned technique followed by three exercise sessions. Exercises prescribed were the same for everyone. All patients met the five criteria for a positive clinical prediction rule. That means they had a high probability of getting relief of back pain with a thrust manipulation manual therapy technique.

In addition to having low back pain with or without leg pain (sciatica) painful symptoms had to be present for less than 16 days to meet the clinical prediction rule (CPR). Other criteria in the CPR included: the pain did not go down past the knee, at least one spinal segment was hypomobile (stuck or lacking full motion), and at least one hip had 35-degrees (or more) of internal (inward) rotation range of motion.

A specific test for fear-avoidance behaviors was also administered. Patients with high scores on this test are fearful of movement and tend to avoid doing anything they think might cause pain. Patients with low scores on the test were more likely to benefit from manual therapy. When a patient met four of these five criteria for the clinical prediction rule, then they could be (randomly) assigned to the 1) the supine thrust manipulation group, 2) sidelying thrust manipulation group, or 3) nonthrust manipulation technique group.

The authors described each technique and provided photos of a therapist performing each one. The supine thrust manipulation was the treatment used when they first developed and tested the clinical prediction rule. The other two treatment techniques were added in this study for comparison. Spinal motion and strengthening the core (trunk) muscles formed the basic exercise program. These exercises were also used during the original studies to develop the prediction rule.

After completing the treatment and exercise program, patients were rechecked at one week, four weeks, and after six months. Patients were asked about any side effects from the treatment such as muscle spasm, fatigue, stiffness, or pain/discomfort. One in four patients experienced at least one side effect but this was not linked with the type of manual therapy treatment they received. Most of the time, when a problem occurred, it was worsening pain with increased stiffness within the first few hours of treatment. These symptoms went away gradually over the next 48 hours.

As far as which treatment(s) were most effective, they found that the two thrust manipulations performed in different positions (on the back, on the side) were equally beneficial. Patients in the non-thrust group had significantly less benefit in the first month of follow-up. By the end of six months, there was no difference in pain or function from one group to the other. The results of all test scores favored early treatment with thrust manipulation and supported the clinical prediction rule using the alternate thrust technique (sidelying) as well.

Patients from different geographical areas were included in this study in an attempt to see if the manual therapy treatments would meet the clinical prediction rule somewhere besides where the main researchers were working. In other words, can the clinical prediction rule be used in other settings besides the one it was developed in? Early results suggest yes, the clinical prediction rule can be generalized to other settings but more research is needed to confirm this finding.

Joshua A. Cleland, PT, PhD, 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. In Spine. December 1, 2009. Vol. 14. No. 25. Pp. 2720-2729.

 Post to Del.icio.us

 Email to a Friend



As you know, Puma shoes and jerseys are word -class international brands, the quality of puma is guaranteed, with the develop of puma company technology, more and more series puma shoes and jersey was come on market,, Zapatillas puma, calzoncillos calvin klein are all popular in the market.feiduhuilan

Physical Therapist found for

Physical Therapist found for the better treatment for the lower back pain can give good benefits to the patients suffering this kind of pains..

Pet Urns

Low back pain is very

Low back pain is very harmful for us.Physical therapists are trying to find affective way to relieve the pain. They are developing the process day by day.

casino en ligne

Burberry is the world famous

Burberry is the world famous brand. Choosing suitable Burberry Bags and taking it outside is a successful performance. Please take action to our Burberry Outlet which includes Burberry Handbags now we offer more privilege.

It is a educative site I

It is a educative site I like this site very much.Because it can solve my many problem.I always update in this site and all article.Low back pain is very harmful for human.Physical treatment is tryiny to solve this problem.

Berber carpet


We offer the Evisu , our Evisu Jeans is made of good material , and Evisu Clothing is the good choice in winter , you can enjoy more discount in our store!


The Balenciaga Handbags are accepted more and more people, with the development of Balenciaga brand, the quality of Balenciaga Bags are reliable in our Balenciaga Outlet store!


The Manolo Blahnik pumps and Manolo Blahnik shoes are well-loved for their great fit and exceptional performance. You can have a look at the Manolo Blahnik sale shop online.

chaussures timberland

I’m also excited about one thing that chaussures timberland isn’t new at all: the chance to experience the creativity and craft of storytellers from all over the world. My favorite moments of the Festival are those I spend in the theatres.

The CPR is great news for

The CPR is great news for people with lumbar asymptomatic diseases. If I were to take the decision, I`d better go for such a therapy program than for random pain-killers of which side effects I used to experience and they weren`t quite pleasant. Also make sure you get alternative advise for the medicines you are using. There are pain killers that can cause behavioral dysfunctions, anxiety or mood swings. If you use them inadequately, you might need
or some similar therapies in response to the substances that were harmful to your organism.

It includes information

It includes information about active physical therapy treatments, also known as exercises I like to discuss more about this thanks for sharing the information.
Jack - Doctors Excuse

As far as which treatment(s)

As far as which treatment(s) were most effective, they found that the two thrust manipulations performed in different positions (on the back, on the side) were equally beneficial.

intranet 2.0
sharepoint intranets

silk scarves

Silk scarves are one of the most recognized products across the world. When you attend a dinner,silk scarves add the elegance and grace to a dress.A cashmere scarf is one of the most important tools of the fashion world because of its versatile ability to just be perfect and suitable with just about any outfit that you could think of.
The wool scarves are soft, warm and always fashionable, so in the cold winter, they will be a good choice for you.
Silk scarves are just widely used for women and men. Dress designers are coming up with Silk scarves that go with the figure of young women as well. They do not fit significant and ungainly exactly how most males prefer their Silk scarves. Silk scarves for women are created to fit a woman’s body to still highlight her body. The urban look with the Silk scarf compliments both ladies and men any time wearing a great pair of denims and certain fly shoes.
You don't have to search all over during times of a fashion emergency because possessing a scarf is considered the best answer to all of your wardrobe woes. In an effort to stay casual chic, it is almost certainly a big must have to have a cashmere scarf.

moscow apartments

i would like to thanks for sharing this information. thanks
moscow apartments

chempornet appreciate your info

Chempornet want to says, Thanks a lot for a bunch of good tips. I look forward to reading more on the topic in the future. Keep up the good work! This blog is going to be great resource. Love reading it

Harga Jual Blackberry iPhone Laptop Murah - Portal Berita Indonesia - idblogNews -

Useful post for me

I've read the same topic with your post, but you discuss it in a clear and easy to read. Thank you for publishing this very useful article.

Blogger Templates - SEO tutorial - Belajar SEO

The daughter of Samuel

The daughter of Samuel August Ericsson and Hanna Johnsson. She had two sisters. Her brother, Gunnar Ericsson, eventually became a member of the Swedish parliament. Thanks.
Carbon Fiber Paddle

hi thanks again for your

hi thanks again for your article, it's me again...i really like to be here

Berita Terkini - Berita - Business Ideas 2011



mulberry outlets

Spinal problems always torment old people, I wonder if your therapy will really help. If it does, it will benefit lots of people, I am a fashion loving person, I love mulberry outlets,good price Oakley sunglasses and mac makeup kopen,Mac Brush, Mulberry Bayswater,
Oakley special edition
, I hope your work will help more people.





What a Great Article it its

What a Great Article it its really informative and innovative keep us posted with new updates. its was really valuable. thanks a lot
Austin Remodeling Company


Check out Increase.com, you can get credits there much faster, you can also get twitter followers, Facebook fans, you tube subscribers and video views. Check it at.

I got lot of useful

I got lot of useful information from this site. I recommended every one to read this site,Great articles. Thanks for sharing!
Round Rock Window Company

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.

*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

All content provided by eORTHOPOD® is a registered trademark of Medical Multimedia Group, L.L.C.. Content is the sole property of Medical Multimedia Group, LLC and used herein by permission.

Back to top

MySpace Tracker