Low back pain and manipulation

Manipulation 1


I recently participated in an excellent teleconference sponsored by the Canadian Physiotherapy Association and presented by Eric Parent, physiotherapist and researcher with the University of Alberta.  The title was “The treatment-based classification system for low back pain: Updated with a prediction rule to identify responders to extension exercises”.   The topic was using research to predict which clients are most likely to respond to spinal manipulation, stabilization or “core exercises”, traction and extension (backward bending) exercises.

The good news is that research supports what physiotherapists have said for many years. When treatment for low back pain is varied according to the findings seen during a thorough assessment, pain relief and return to function is much greater than when the same treatment is applied across the board.


For example, if your physiotherapist finds you have 4 of the following 5 factors: symptoms of low back pain for less than 16 days, pain which is not radiating below your knee, not experiencing high levels of fear of moving about, passive hip internal rotation mobility of more than 35 degrees (in at least one hip) and stiffness of at least one segment of your lumbar spine, then spinal manipulation would be a good choice for your physiotherapist to use. Your chances of having pain relief and improved function resulting from the manipulation, in combination with mobility exercises and remaining active within tolerance , would be 93 %.  You would not have to meet these criteria to benefit from manipulation. Participants in this study received 3 treatments within a one week time period and then were followed up one week and one month after treatment.


This line of research is relatively new but exciting for therapists and people with low back pain. The bottom line is that your physiotherapist should be taking a thorough history and performing a detailed physical examination prior to deciding the best treatment for you.  Please be aware that even if you don’t fit one of the patterns described there is a strong probability that you can benefit from physiotherapy. If you have more questions feel free to contact one of our highly trained team of physiotherapists at West 4th Physiotherapy.

In my next post I will review some of those other treatment options which contribute to successful low back therapy.

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