A Randomized Trial Comparing Interventions in Patients with Lumbar Posterior Derangement

Abstract

This pretest/posttest study compared the outcomes of people with low back pain who were treated with exercises or joint mobilization. Thirty-one patients referred to physical therapy with a physician's diagnosis of lumbar radiculopathy were initially recruited as subjects. All 31 patients were examined and treated by a physical therapist with 17 years of clinical experience. Following the initial examination, those subjects classified into the derangement category (n=25) were randomly assigned to a group that received joint mobilization (n=10) or a group that performed therapeutic exercises as described by the McKenzie method (n=15). The remaining six patients were not classified into the derangement category and were not included in the analysis. The subjects were also classified according to the Quebec Task Force (QTF) system. The patient's pain as reported on the verbal analog scale and the patient's perceived level of function as indicated by Oswestry scores were recorded at the initial evaluation and following the third physical therapy visit. The McKenzie group performed exercises that were based on their response to repeated movements and the mobilization group received manual techniques based on active and passive movements and passive intervertebral motion testing. All subjects were instructed in postural correction. Data were analyzed through the use of t-tests and correlation coefficients. Subjects who performed therapeutic exercise were found to have significantly greater decreases in pain level (p<.014) and significantly greater improvement in function (p<.032) as compared to the mobilization group. Low correlations were found in regard to QTF classification and the outcome measures. The results indicated that exercises based on repeated movements might be more beneficial in terms of pain reduction and recovery of function than joint mobilization in the early stages of recovery from lumbar disc derangement. The results also point toward the importance of including repeated movements as part of the lumbar evaluation to assist in the prescription of appropriate therapeutic exercise.