Immediate effects of a lumbar spine manipulation on pain sensitivity and postural control in individuals with nonspecific low back pain: a randomized controlled trial

Jefferson Fagundes Loss, Luciano de Souza da Silva, Iã Ferreira Miranda, Sandro Groisman, Edgar Santiago Wagner Neto, Catiane Souza, Cláudia Tarragô Candotti, Jefferson Fagundes Loss, Luciano de Souza da Silva, Iã Ferreira Miranda, Sandro Groisman, Edgar Santiago Wagner Neto, Catiane Souza, Cláudia Tarragô Candotti

Abstract

Background: According to the American Physical Therapy Association, there is strong evidence to show that vertebral mobilization and manipulation procedures can be used to improve spinal and hip mobility and reduce pain and incapacity in low back pain patients that fit the clinical prediction rule.

Objectives: To evaluate the immediate effects of high-velocity low-amplitude (HVLA) manipulation on pain and postural control parameters in individuals with nonspecific low back pain.

Methods: This study used a participant-blinded and assessor-blinded randomized controlled clinical trial involving a single session, in which 24 participants were randomly distributed into control (simulated manipulation) and intervention (HVLA lumbar manipulation) groups. The primary (pain: subjective pain intensity and pressure pain threshold) and secondary outcomes (postural control: ellipse area, center of pressure [COP] excursion, COP RMS velocity, and differences between the COP and center of projected gravity) were evaluated before and after the session using a numerical pain scale, algometer, and a force platform. For all outcomes, multiple mixed 2 (group) × 2 (time) ANOVAs were performed.

Results: For the subjective pain intensity, only time was significant as a main effect, where pre-intervention presented a greater value then post-intervention (F [1.44] = 4.377; p = 0.042; r = 0.30). For the pressure pain threshold no significant effect was found. For the postural control parameters, as a main effect, only the ellipse area was significantly greater in the control group (F [1.44] = 6.760; p = 0.013; effect size = 0.36).

Conclusions: There was a reduction in subjective pain intensity, evaluated using a numerical scale, in both the intervention and control groups immediately after the intervention, suggesting that the spinal manipulation had a similar effect to the placebo procedure. No effect of HVLA lumbar manipulation was identified for postural control variables in either the intervention or control groups.

Trial registration: The study was registered at ClinicalTrials.gov under the number NCT02312778, registered at 14 September 2014.

Keywords: Algometry; HVLA lumbar manipulation; Non-specific low back pain; Numerical pain rating scale; Pain sensitivity; Postural parameters.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Initial position for both IG and CG
Fig. 2
Fig. 2
Final position for simulated manipulation of CG participants
Fig. 3
Fig. 3
Final position for manipulation of IG participants
Fig. 4
Fig. 4
Pressure pain threshold assessment
Fig. 5
Fig. 5
Study flowchart

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