Thrust techniques do not outweigh nonthrust for low-back pain

By Lucy Piper, Senior medwireNews Reporter

Early use of thrust manipulation does not offer improved outcomes and a quicker recovery from low-back pain compared with nonthrust techniques, US study findings suggest.

Chad Cook, from Walsh University in North Canton, Ohio, and colleagues found no difference between thrust and nonthrust manipulation in terms of pain, disability, recovery rate, and days spent in care when used early in the intervention of patients with mechanical low-back pain.

They also report in Manual Therapy that personal equipoise had a significant effect on study outcome.

"Only 6/17 physiotherapists had true personal equipoise and did not have expectations that one technique would lead to better outcomes than another," they write.

"Indeed, personal equipoise was significantly associated with outcomes associated with pain and disability in our multivariate model."

They explain: "It suggests that a lack of personal equipoise can impact outcome and that past studies involving manual therapy may have also been influenced by a lack of equipoise."

A total of 149 patients, aged at least 18 years, with low-back pain received care over an average of 35 days. They were randomly assigned to receive thrust manipulation or nonthrust manipulation from highly skilled physiotherapists with formal manual therapy training.

The nonthrust procedures consisted of a variety of manual therapy techniques, including mobilization with movements, unilateral posterior-anterior, and a central posterior-anterior, performed in prepositions or neutral spine positions. Most of the thrust manipulations included a rotational manipulation in sidelying.

To reflect actual clinical practice, the physiotherapists were also able to adjust treatments after the first two visits, mostly adding core stabilization or general strengthening exercises as adjunctive treatment.

Both interventions resulted in significant within-session improvements from baseline to the end of the second visit and from the end of the second visit to discharge.

However, they did not differ significantly in terms of pain at discharge, with average scores of 1.9 and 1.8 out of a possible 10 for nonthrust and thrust manipulation, respectively, or rate of recovery, at 80.1% and 78.3%, respectively.

Discharge scores on the Oswestry Disability Index were also similar (17.2 and 14.9, respectively) and there was no significant difference in the number of days spent in care (37.6 and 33.8, respectively).

"The findings suggest that there is no difference between early use of TM [thrust manipulation] or NTM [non-thrust manipulation]," the researchers conclude.

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