A recent randomized, controlled trial was performed to identify patients with low back pain most likely to benefit from spinal manipulation.
The purpose of the study was to identify which patients with low back pain will most likely benefit from a manipulation and which ones will least likely benefit. 131 patients with low back pain were randomly assigned to 2 groups. Group 1 received a manipulation plus exercise and group 2 performed exercise alone.
5 clinical prediction rules were identified during the study. The 5 rules were:
1. Low back pain less than 16 days
2. No symptoms below the knee
3. A score of less than 19 on the fear-avoidance beliefs questionnaire
4. A hypomobile segment of the lumbar spine on physical examination (stiff lumbar joint)
5. 35 degrees of rotation in at least one hip
Results of this study show that a patient who was positive on at least 4 of 5 of the prediction rules and received a manipulation had a 92% chance of a successful outcome.
Manipulate everyone, get a less than average result, manipulate the right patients and get amazing results. Not everyone needs a manipulation. Some patients require specific stabilization exercises for the spine. Others benefit more from a McKenzie approach.