Low back pain is the third most reported complaint after headache and chronic fatigue, and more than 80% of the population will experience low back pain at some point in their lives.
Objectıve
We conducted this study to investigate the effects of instrument-assisted manipulation (IAM) and mobilization with movement (MWM) on joint range of motion (ROM), pain, proprioception, endurance, back awareness, and disability in individuals with chronic nonspecific low back pain (CNSLBP).
Methods
51 participants with CNSLBP were randomized to one of three groups: (1) MWM; (2) IAM; or (3) core exercise. Joint ROM, pain, proprioception, endurance, back awareness, and disability were assessed at baseline, week 2 and 6.
Results
Joint ROM and activity pain scores increased in all groups (p < 0.05). Both activity and resting pain improved in the MWM group (p < 0.001; p = 0.004). Most measures related to proprioception improved in the MWM group (p = 0.005; p = 0.016; p = 0.016). Endurance increased in all groups, but the flexor endurance increase was higher in the MWM group (p < 0.05). Back awareness and disability increased in all groups (p < 0.05), but disability increased most in MWM group (p = 0.022).
Conclusıons
MWM could effectively improve pain, proprioception, endurance, and disability.
ChildsJDFritzJMFlynnTW, et al.A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med2004; 141: 920–928.
2.
ClelandJAFritzJMKuligK, et al.Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who atisfy a clinical prediction rule: a randomized clinical trial. Spine (Phila Pa 1976)2009; 34: 2720–2729.
3.
WandBCatleyMRabeyM, et al.Early intervention for the management of acute low back pain: a single-blind randomized controlled trial of biopsychosocial education, manual therapy, and exercise. Spine (Phila Pa 1976)2004; 29: 2350–2356.
4.
CurtisPCareyTSEvansP, et al.Training primary care physicians to give limited manual therapy for low back pain: patient outcomes. Spine (Phila Pa 1976)2000; 25: 2954–2961.
5.
HayEMMullisRLewisM, et al.Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice. Lancet (London, England)2005; 365: 2024–2030.
6.
SuzukiHKanchikuTImajoY, et al.Diagnosis and characters of non-specific low back pain in Japan: the Yamaguchi low back pain study. PLoS One2016; 11: e0160454.
7.
HancockMJMaherCGLatimerJ, et al.Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet2007; 370: 1638–1643.
8.
EisenbergDMPostDEDavisRB, et al.Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial. Spine (Phila Pa 1976)2007; 32: 151–158.
9.
KonstantinouKFosterNRushtonA, et al.Flexion mobilizations with movement techniques: the immediate effects on range of movement and pain in subjects with low back pain. J Manipulative Physiol Ther2007; 30: 178–185.
10.
KonstantinouKFosterNRushtonA, et al.The use and reported effects of mobilization with movement techniques in low back pain management; a cross-sectional descriptive survey of physiotherapists in Britain. Man Ther2002; 7: 206–214.
11.
VicenzinoBPaungmaliATeysP. Mulligan's mobilization-with-movement, positional faults and pain relief: current concepts from a critical review of literature. Man Ther2007; 12: 98–108.
12.
MulliganBR. Manual therapy: NAGS, SNAGS, MWMS, Etc. Minnesota: OPTP, 2004.
13.
HeggannavarAKaleA. Immediate effect of modified lumbar SNAGS in non-specific chronic low back patients: a pilot study. Int J Physiother Res2015; 3: 1018–1023.
14.
HidalgoBPitanceLHallT, et al.Short-term effects of mulligan mobilization with movement on pain, disability, and kinematic spinal movements in patients with nonspecific low back pain: a randomized placebo-controlled trial. J Manipulative Physiol Ther2015; 38: 365–374.
15.
Gevers-MontoroCProvencherBDescarreauxM, et al.Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain. Eur J Pain2021; 25: 1429–1448.
16.
SchneiderMHaasMGlickR, et al.A comparison of spinal manipulation methods and usual medical care for acute and sub-acute low back pain: a randomized clinical trial. Spine (Phila Pa 1976)2015; 40: 209–217.
17.
NambiGKamalWEsS, et al.Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: a randomized controlled study. Eur J Phys Rehabil Med2018; 54: 880–889.
18.
KellerTSCollocaCJMooreRJ, et al.Three-dimensional vertebral motions produced by mechanical force spinal manipulation. J Manipulative Physiol Ther2006; 29: 425–436.
19.
ReedWPickarJSozioR, et al.Characteristics of paraspinal muscle spindle response to mechanically assisted spinal manipulation: a preliminary report. Manip Physiol Ther2017; 40: 371–380.
20.
CollocaCKellerTBlackP, et al.Comparison of mechanical force of manually assisted chiropractic adjusting instruments. J Manipulative Physiol Ther2005; 28: 414–422.
21.
SheararKCollocaCWhiteH. A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome. J Manipulative Physiol Ther2005; 28: 493–501.
22.
ChoHKimEKimJ. Effects of the CORE exercise program on pain and active range of motion in patients with chronic low back pain. J Phys Ther Sci2014; 26: 1237–1240.
23.
MenseS. Nociception from skeletal muscle in relation to clinical muscle pain. Pain1993; 54: 241–289.
24.
MerkleSLSlukaKAFrey-LawLA. The interaction between pain and movement. J Hand Ther2020; 33: 60–66.
25.
LairdRAGilbertJKentP, et al.Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord2014; 15: 229.
26.
EbrahimiHBlaouchiREslamiR, et al.Effect of 8-week core stabilization exercises on low back pain, abdominal and back muscle endurance in patients with chronic low back pain due to disc herniation. Phys Treat - Specif Phys Ther2014; 4: 25–32.
27.
WandBCatleyMRabeyM, et al.Disrupted self-perception in people with chronic low back pain. Further evaluation of the fremantle back awareness questionnaire. J Pain2016; 17: 1001–1012.
28.
NguyenTRandolphD. Nonspecific low back pain and return to work. Am Fam Physician2007; 76: 1497–1502.
29.
GongW. The influence of lumbar joint mobilization on joint position sense in normal adults. J Phys Ther Sci2014; 26: 1985–1987.
30.
YakutEDügerTÖksüzÇ, et al.Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976)2004; 29: 581–585.
31.
KüçükdeveciAATennantAElhanAH, et al.Validation of the Turkish version of the Roland-Morris Disability Questionnaire for use in low back pain. Spine (Phila Pa 1976)2001; 26: 2738–2743.
32.
ErolEYildizAYildizR, et al.Reliability and validity of the Turkish version of the fremantle back awareness questionnaire. Spine (Phila Pa 1976)2019; 44: E549–E554.
33.
MacDermidJCArumugamVVincentJI, et al.Reliability of three landmarking methods for dual inclinometry measurements of lumbar flexion and extension. BMC Musculoskelet Disord2015; 16: 121.
34.
McGillSChildsALiebensonC. Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Rehabil1999; 80: 941–944.
35.
LakhaniENookBHaasM, et al.Motion palpation used as a postmanipulation assessment tool for monitoring end-feel improvement: a randomized controlled trial of test responsiveness. J Manipulative Physiol Ther2009; 32: 549–555.
36.
HingWHallTRivettD, et al.The mulligan concept of manual therapy-ebook: textbook of techniques. Australia: Elsevier Health Sciences, 2014.
37.
StokesIAFGardner-MorseMGHenrySM. Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups. Clin Biomech2011; 26: 797–803.
38.
JavadianYAkbariMTalebiG, et al.Influence of core stability exercise on lumbar vertebral instability in patients presented with chronic low back pain: a randomized clinical trial. Casp J Intern Med2015; 6: 98.
39.
MoonHJChoiKHKimDH, et al.Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Ann Rehabil Med2013; 37: 110–117.
40.
McGillS. Low back disorders: evidence-based prevention and rehabilitation. Champaign, IL: Human Kinetics, 2015.
41.
PortneyLG. Foundations of clinical research: applications to evidence-based practice. 4th ed. Philadelphia, PA: F.A. Davis Company, 2020.
42.
HussienHMAbdel-RaoofNAKattabeiOM, et al.Effect of mulligan concept lumbar SNAG on chronic nonspecific low back pain. J Chiropr Med2017; 16: 94–102.
43.
IanuzziAPickarJKhalsaP. Relationships between joint motion and facet joint capsule strain during cat and human lumbar spinal motions. J Manipulative Physiol Ther2011; 34: 420–431.
44.
OsteloRWde VetHC. Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol2005; 19: 593–607.
45.
AnapDKhatriSZambreB. Effectiveness of sustained natural apophyseal glides and Maitland mobilization in facet joint syndrome: a single blind randomized control pilot study. Int J Heal Sci Res2014; 4: 142–150.
