Efficacy of “therapist-selected” versus “randomly selected” mobilisation techniques for the treatment of low back pain: A randomised controlled trial

Abstract

The aim of this study was to establish whether the mobilisation technique selected by the treating physiotherapist is more effective in relieving low back pain than a randomly selected mobilisation technique. Two manipulative physiotherapists and 140 subjects suffering non-specific low back pain participated. Baseline measurements were taken before treatment allocation; the therapist then assessed subjects and nominated the preferred treatment grade, spinal level to be treated and mobilisation technique to be used. The subjects were then randomly allocated to one of two groups. One group received the preferred mobilisation technique as selected by the therapist; the other group received a randomly assigned mobilisation technique. All mobilisation treatments were applied to the nominated spinal level using the nominated treatment grade. Follow-up measures were taken immediately after intervention. Two-way ANOVA was used to analyse the data; the first factor was the treatment group and the second factor was the direction of the patient s most painful movement. The choice of mobilisation treatment had no effect on any outcome measure investigated in this study; however, post hoc tests revealed that mobilisation treatment applied to the lower lumbar levels had a greater analgesic effect than when applied to upper lumbar levels. The results of this study confirm that lumbar mobilisation treatment has an immediate effect in relieving low back pain, however the specific technique used seems unimportant.

Subgrouping Patients With Low Back Pain: Evolution of a Classification Approach to Physical Therapy

“…26,30 Although evidence is sparse, a few studies have found greater benefit from thrust manipulation techniques versus nonthrust mobilization for the lumbosacral region. 59,92 Although manipulation is generally recommended as superior to mobilization procedures, 20 there is presently no evidence for the superiority of one manipulation technique over another.…”

Thoracic Spine Manipulation for the Management of Patients With Neck Pain: A Randomized Clinical Trial

“…One clinician performed 9,10,20 However, this hypothesis requires further investigation. We also used an electro/thermal therapy program in this study, which doesn't necessarily reflect common physical therapist practice.…”

Acute effects of Maitland’s central posteroanterior mobilization on youth with low back pain.

“…(21) In a study, from the 140 volunteers with non-specific LBP who received lumbar mobilization techniques (PA, Unilateral posteroanterior or Transverse pressure) was possible to observe significant improvement in reducing the immediate pain by VAS when applied in the low lumbar spine (L4-L5) when compared to the high lumbar spine (L1-L3) and no significant difference between techniques (1 minute each vertebra twice in one session). (22) The results obtained in this study showed no significant difference, it is believed this may be due to differences of the protocols.…”