Effects of physical therapy treatments with and without spinal mobilization in individuals with acute nonspecific low back pain: a randomized trial

Abstract

Introduction Low back pain (LBP) is one of the most prevalent problems, it was estimated that the lifetime prevalence of LBP is at least 60 to 70 percent'2. According to the diagnostic triage, LBP could be divided into nonspecific LBP, radicular syndrome, and specific pathologic change3 Among LBP patients, most of them have the diagnosis of nonspecific LBP4. The recovery of LBP, it was estimated that 30-60 percent of LBP patients recover in one week, 60-90 percent in 6 weeks, and 95 percent in 12 weeks 4,5 While, about 40 percent of LBP patients have recurrences within 6 months6 There are many options for LBP treatments such as spinal manipulative therapy (SMT), deep massage, therapeutic exercise, ultrasound therapy, and heat or cold modalities7 Among these modalities, they have their own specific therapeutic effects with different physiological explanations. Spinal manipulative therapy or SMT includes both manipulation and mobilization. Manipulation is a high velocity thrust of small amplitude performed at the limit of available movement, and mobilization is defined as low-velocity repetitive oscillations8. There are some good-quality systematic reviews indicating that SMT is beneficial in pain reduction over sham treatments9,11, and in function improvement over sham treatments9,11,12. In addition, It was reported that mobilization has the effect of pain reduction in LBP patients13,14 However, SMT does not maintain the benefits in long term for acute LBP9,10,12. Besides SMT, other physical therapy modalities seem to be unclear in their therapeutic effect for acute LBP patients15. Practically, in a treatment session, more than one intervention are chosen for treating LBP patients after the relevant physical examination has been conducted by physical therapists16. It is interesting that the use of treatment combination may be more effective for LBP patients. Therefore, the objective of this study was to investigate spinal mobilization with physical therapy interventions in individuals with acute nonspecific LBP, and to compare this group with a control group treated with physical therapy interventions only The hypothesis was that spinal mobilization with physical therapy interventions is more effective.