Manual therapy for LBP with associated disc degeneration

Curious about the effects of a 5-week, once a week session of 10-minute spinal mobilisation to the levels of the spine with disc degeneration as shown on MRI for patients with chronic low back pain?

This RCT compared the effectiveness of spinal mobilisation/manual therapy (MT) vs. conventional physiotherapy (CP) vs. sham treatment (ST) in subjects with low back pain and associated spinal disc degeneration.

The 75-subject pool consisted of low back pain sufferers who were referred for physiotherapy after orthopaedic physician visit. Inclusion criteria included pain in the lumbar region for more than three months accompanied by MRI scan within 12 months. Exclusion criteria included: history of spinal surgery, autoimmune disease, spondylolysis/listhesis, fractures, pregnancy, cardio-respiratory pathology, stroke, CE syndrome, continuous use of pain medications, spinal inflammation, spinal tumor, subjects receiving immunosuppressant medication, corticosteroid medication use in the last month and osteoporosis.

These subjects were then allocated randomly to 3 groups to receive either MT, CP or ST. The MT group received once a weekly, 10-minute spinal mobilisation to the levels of the spine shown with disc degeneration. The CP group received once a weekly, 5 minutes of static stretch to the lower limbs, 20 minutes of TENS in the lumbar area and 15 minutes of massage to the lower back region. The ST group received once a weekly, 10-minute gentle touch to the skin overlying the lumbar spine.

Based on measurements taken by numerical pain rating scale (NPRS) and two questionnaires (Oswesrtry and Roland-Morris) the trial showed significant differences between MT and ST group and between the MT and CP group. No significant difference was observed between the ST and CP group.

A 6-month follow up was conducted through asking the subject whether they sought for professional help regarding their low back pain. In the MT group, one sought further treatment, 10 in the CT group and 21 in the ST group.

This trial was able to show positive results of manual therapy perhaps by their utilisation of the comprehensive exclusion criteria.

> From: Krekoukias et al., J Man Manip Ther 25 (2017) 66-73. All rights reserved to Taylor & Francis Group. Click here for the online summary.