Spinal Manipulation: Difference between revisions
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The use of spinal manipulation as part of treatment for low back pain is recommended by several clinical practice guidelines, including the [http://www.nzgg.org.nz/guidelines/0072/acc1038_col.pdf New Zealand Guidelines for Acute Low Back Pain], and the recently published [http://www.nice.org.uk/nicemedia/pdf/CG88fullguideline.pdf NICE guidelines.]<br> <br> | The use of spinal manipulation as part of treatment for low back pain is recommended by several clinical practice guidelines, including the [http://www.nzgg.org.nz/guidelines/0072/acc1038_col.pdf New Zealand Guidelines for Acute Low Back Pain], and the recently published [http://www.nice.org.uk/nicemedia/pdf/CG88fullguideline.pdf NICE guidelines.]<br> <br> | ||
== Clinical Prediction Rule for Manipulation <ref>1. Fritz, Julie M. PT, PhD, ATC, Cleland, Joshua A. PT, PhD, OCS, FAAOMPT, and Childs, John D. PT, PhD, MBA, OCS, FAAOMPT, “Subgrouping Patients With Low Back Pain: Evolution of a Classification Approach to Physical Therapy,” Journal of | == Clinical Prediction Rule for Manipulation <ref>1. Fritz, Julie M. PT, PhD, ATC, Cleland, Joshua A. PT, PhD, OCS, FAAOMPT, and Childs, John D. PT, PhD, MBA, OCS, FAAOMPT, “Subgrouping Patients With Low Back Pain: Evolution of a Classification Approach to Physical Therapy,” Journal of Orthop Sports Physical Therapy 37, no. 6 (June 2007): 290-302.</ref> == | ||
The following five factors are the criteria included in the five factor predictor rule for manipulation: | The following five factors are the criteria included in the five factor predictor rule for manipulation: | ||
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Description
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The underlying pathological cause of low back pain (LBP) is only determined in about 15% of all cases. Because of this, there has been much confusion and debate about the best way to treat patients with LBP. There have been numerous studies done to determine the effectiveness of different treatment interventions for these patients. Evidence has been conflicting regarding the effectiveness of spinal manipulation as an intervention in this patient population.However, Flynn et. al determined that patients that meet certain criteria were more likely to experience short-term improvements with spinal manipulation. A clinical prediction rule was developed in order to identify these patients with LBP who will most likely benefit from spinal manipulation. Spinal manipulation is a sub-group of the Treatment-Based Classification Approach for low back pain.
The use of spinal manipulation as part of treatment for low back pain is recommended by several clinical practice guidelines, including the New Zealand Guidelines for Acute Low Back Pain, and the recently published NICE guidelines.
Clinical Prediction Rule for Manipulation [1][edit | edit source]
The following five factors are the criteria included in the five factor predictor rule for manipulation:
- Pain lasting less than 16 days
- No symptoms distal to the knee
- FABQ score less than 19
- Internal Rotation of greater than 35 degrees for at least one hip
- Hypomobility of a least one level of the lumbar spine
However, the two most important identifiers for manipulation are:
- Pain lasting less than 16 days
- No symptoms distal to the knee
Clinical Presentation[edit | edit source]
Key Evidence
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Fritz, Cleland, and Childs published an article in 2007 entitled "Subgrouping Patients With Low Back Pain: Evolution of a Classification Approach to Physical Therapy" which lays out the Treatment Based Classification Approach and explains the classification critia for the different intervention subgroups.
In 2002 Flynn et al.[2] developed a clinical prediction rule for classifying patients with low back pain into the spinal manipulation intervention group. The CPR included the five factors that are mentioned above. This CPR was validated in a study done by Childs et al.[3] which was published in 2004. This study found that the treatment effects were the greatest in patients who met at least 4 of the 5 factors.
Resources[edit | edit source]
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References[edit | edit source]
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- ↑ 1. Fritz, Julie M. PT, PhD, ATC, Cleland, Joshua A. PT, PhD, OCS, FAAOMPT, and Childs, John D. PT, PhD, MBA, OCS, FAAOMPT, “Subgrouping Patients With Low Back Pain: Evolution of a Classification Approach to Physical Therapy,” Journal of Orthop Sports Physical Therapy 37, no. 6 (June 2007): 290-302.
- ↑ Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002;27(24):2835-2843.
- ↑ Childs JD, Fritz JM, Flynn TW, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann. Intern. Med. 2004;141(12):920-928.
