Immediate Effects of Region-Specific and Non–Region-Specific Spinal Manipulative Therapy in Patients With Chronic Low Back Pain: A Randomized Controlled Trial

Abstract

Manual therapists typically advocate the need for a detailed clinical examination to decide which vertebral level should be manipulated in patients with low back pain. However, it is unclear whether spinal manipulation needs to be specific to a vertebral level. The purpose of this study was to analyze the immediate effects of a single, region-specific spinal manipulation defined during the clinical examination versus a single non-region-specific spinal manipulation (applied on an upper thoracic vertebra) in patients with chronic nonspecific low back pain for the outcome measures of pain intensity and pressure pain threshold at the time of the assessment. This was a 2-arm, prospectively registered, randomized controlled trial with a blinded assessor. The study was conducted in an outpatient physical therapy clinic in Brazil. The study participants were 148 patients with chronic nonspecific low back pain (with pain duration of at least 12 weeks). The randomization schedule was generated by an independent statistician and was concealed by using consecutively numbered, sealed, opaque envelopes. A single high-velocity manipulation was administered to the upper thoracic region of the participants allocated to the non-region-specific manipulation group and to the painful lumbar levels of the participants allocated to the region-specific manipulation group. Pain intensity was measured by a 0 to 10 numeric pain rating scale. Pressure pain threshold was measured using a pressure algometer. It was not possible to blind the therapist and participants. A total of 148 patients participated in the study (74 in each group). There was no loss to follow-up. Both groups improved in terms of immediate decrease of pain intensity; however, no between-group differences were observed. The between-group difference for pain intensity and pressure pain threshold were 0.50 points (95% confidence interval=-0.10 to 1.10) and -1.78 points (95% confidence interval=-6.40 to 2.82), respectively. No adverse reactions were observed. The immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region-specific versus non-region-specific manipulation techniques in patients with chronic low back pain.