A randomized clinical trial comparing non-thrust manipulation with segmental and distal dry needling on pain, disability, and rate of recovery for patients with non-specific low back pain

D Griswold, F Gargano, K E Learman, D Griswold, F Gargano, K E Learman

Abstract

Objective: The purpose of this study was to examine the within and between-group effects of segmental and distal dry needling (DN) without needle manipulation to a semi-standardized non-thrust manipulation (NTM) targeting the symptomatic spinal level for patients with non-specific low back pain (NSLBP). Methods: Sixty-five patients with NSLBP were randomized to receive either DN (n = 30) or NTM (n = 35) for six sessions over 3 weeks. Outcomes collected included the oswestry disability index (ODI), patient specific functional scale (PSFS), numeric pain rating scale (NPRS), and pain pressure thresholds (PPT). At discharge, patients perceived recovery was assessed. Results: A two-way mixed model ANOVA demonstrated that there was no group*time interaction for PSFS (p = 0.26), ODI (p = 0.57), NPRS (p = 0.69), and PPT (p = 0.51). There was significant within group effects for PSFS (3.1 [2.4, 3.8], p = 0.018), ODI (14.5% [10.0%, 19.0%], p = 0.015), NPRS (2.2 [1.5, 2.8], p = 0.009), but not for PPT (3.3 [0.5, 6.0], p = 0.20). Discussion: The between-group effects were neither clinically nor statistically significant. The within group effects were both significant and exceeded the reported minimum clinically important differences for the outcomes tools except the PPT. DN and NTM produced comparable outcomes in this sample of patients with NSLBP. Level of evidence: 1b.

Keywords: Low back pain; dry needling; manual therapy.

Figures

Figure 1.
Figure 1.
Dry needling protocol at the symptomatic level of lumbar spine, level above, and level below. (1) Lower extremity innervation zones needled represented by dots. (2).
Figure 1.
Figure 1.
Dry needling protocol at the symptomatic level of lumbar spine, level above, and level below. (1) Lower extremity innervation zones needled represented by dots. (2).
Figure 2.
Figure 2.
Non-thrust manipulation.
Figure 2.
Figure 2.
Non-thrust manipulation.
Figure 3.
Figure 3.
CONSORT flow diagram.
Figure 3.
Figure 3.
CONSORT flow diagram.
Figure 4.
Figure 4.
Between-group differences for mean scores on the ODI at baseline, visit 2, visit 4, and visit 6. Error bars represent the 95% confidence interval for mean scores. Between-group differences existed at baseline but no other time point.
Figure 4.
Figure 4.
Between-group differences for mean scores on the ODI at baseline, visit 2, visit 4, and visit 6. Error bars represent the 95% confidence interval for mean scores. Between-group differences existed at baseline but no other time point.
Figure 5.
Figure 5.
Between-group differences on the NPRS for mean scores at baseline, visit 2, visit 4, and visit 6. Error bars represent the 95% confidence interval for mean scores. No between-group differences existed at any time points.
Figure 5.
Figure 5.
Between-group differences on the NPRS for mean scores at baseline, visit 2, visit 4, and visit 6. Error bars represent the 95% confidence interval for mean scores. No between-group differences existed at any time points.

Source: PubMed

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