Relative effectiveness of an extension program and a combined program of manipulation and flexion and extension exercises in patients with acute low back syndrome

Comprehensive Spine Center, University of Pittsburgh Medical Center, PA 15261.

BACKGROUND AND PURPOSE. The relative effectiveness of an extension program and a manipulation program with flexion and extension exercises was examined in patients with low back syndrome. SUBJECTS. Forty-nine patients with less than a 3-month history of low back pain were seen at physical therapy clinics in western Pennsylvania, southern Mississippi, and eastern Missouri during a 6-month period. Twenty-seven of the 49 patients were classified a priori into a treatment-oriented category of extension/mobilization and were then randomly assigned to participate in an extension program or a program of manipulation followed by hand-heel rocks (flexion and extension). Two patients dropped out of the study (1 patient returned to work, and the other patient was unable to comply with the treatment schedule), and 1 patient was eliminated from the study because of magnified illness behavior. The remaining 24 patients (15 male, 9 female; mean age = 44 years, SD = 15, range = 14-73) were assigned randomly and equally to the two groups. Eight physical therapists participated in the study. METHODS. A randomized clinical trial comparing the two regimens was conducted for a 1-week period. Outcome was assessed using an Oswestry Low Back Pain Questionnaire initially (before treatment) and at 3 and 5 days posttreatment, and data were analyzed using a 2 x 3 (group x time) analysis of variance. RESULTS. A significant interaction of the group and time variables was demonstrated, indicating that the rate of positive response was greater in the manipulation/hand-heel rock group than in the extension group. CONCLUSION AND DISCUSSION. In this category of patients with low back pain, the use of manipulation as an adjunct to an ongoing exercise program appears to be warranted.

This article has been cited by other articles:

				J. D Childs and J. A Cleland Development and Application of Clinical Prediction Rules to Improve Decision Making in Physical Therapist Practice Physical Therapy, January 1, 2006; 86(1): 122 - 131. [Full Text] [PDF]

				S. Z George and A. Delitto Clinical Examination Variables Discriminate Among Treatment-Based Classification Groups: A Study of Construct Validity in Patients With Acute Low Back Pain Physical Therapy, April 1, 2005; 85(4): 306 - 314. [Abstract] [Full Text] [PDF]

				J. D. Childs, J. M. Fritz, T. W. Flynn, J. J. Irrgang, K. K. Johnson, G. R. Majkowski, and A. Delitto A Clinical Prediction Rule To Identify Patients with Low Back Pain Most Likely To Benefit from Spinal Manipulation: A Validation Study Ann Intern Med, December 21, 2004; 141(12): 920 - 928. [Abstract] [Full Text] [PDF]

				M. W Werneke and D. L Hart Categorizing Patients With Occupational Low Back Pain by Use of the Quebec Task Force Classification System Versus Pain Pattern Classification Procedures: Discriminant and Predictive Validity Physical Therapy, March 1, 2004; 84(3): 243 - 254. [Abstract] [Full Text] [PDF]

				J. M Fritz, J. M Whitman, T. W Flynn, R. S Wainner, and J. D Childs Factors Related to the Inability of Individuals With Low Back Pain to Improve With a Spinal Manipulation Physical Therapy, February 1, 2004; 84(2): 173 - 190. [Abstract] [Full Text] [PDF]

				W. J.J. Assendelft, S. C. Morton, E. I. Yu, M. J. Suttorp, and P. G. Shekelle Spinal Manipulative Therapy for Low Back Pain: A Meta-Analysis of Effectiveness Relative to Other Therapies Ann Intern Med, June 3, 2003; 138(11): 871 - 881. [Abstract] [Full Text] [PDF]

				R. E Erhard, D. L Riddle, and J. K Freburger When to Use the Manipulation? Physical Therapy, January 1, 2003; 83(1): 78 - 80. [Full Text]

				K. A Olson, M. T Cibulka, R. M Koldehoff, D. L Riddle, J. K Freburger, and North American Orthopaedic Rehabilitation Research "Skilled Mentors" and Reliability Physical Therapy, December 1, 2002; 82(12): 1265 - 1268. [Full Text]

				J. J Godges, D. R Varnum, and K. M Sanders Impairment-Based Examination and Disability Management of an Elderly Woman With Sacroiliac Region Pain Physical Therapy, August 1, 2002; 82(8): 812 - 821. [Abstract] [Full Text] [PDF]

				Philadelphia Panel Members, Clinical Specialty Experts, J. Albright, R. Allman, R. P. Bonfiglio, A. Conill, B. Dobkin, A. A Guccione, S. M Hasson, R. Russo, et al. Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Low Back Pain Physical Therapy, October 1, 2001; 81(10): 1641 - 1674. [Abstract] [Full Text] [PDF]

				G. Watson, K. S Maluf, S. A Sahrmann, L. R Van Dillen, J. M Rothstein, R. Maeda, K. S Maluf, S. A Sahrmann, and L. R Van Dillen Management of Low Back Pain Physical Therapy, May 1, 2001; 81(5): 1147 - 1154. [Full Text]

				B. Chok, R. Lee, J. Latimer, and S. B. Tan Endurance Training of the Trunk Extensor Muscles in People With Subacute Low Back Pain Physical Therapy, November 1, 1999; 79(11): 1032 - 1042. [Abstract] [Full Text] [PDF]

				P. K Levangie Four Clinical Tests of Sacroiliac Joint Dysfunction: The Association of Test Results With Innominate Torsion Among Patients With and Without Low Back Pain Physical Therapy, November 1, 1999; 79(11): 1043 - 1057. [Abstract] [Full Text] [PDF]

				E. Ernst, M.J.B. Wilkinson, L. Harding, A. Malmivaara, T. Aro, and E. Kuosma Treatment of Acute Low Back Pain N. Engl. J. Med., June 29, 1995; 332(26): 1786 - 1787. [Full Text]