Comparing Targeted Thrust Manipulation With General Thrust Manipulation In Patients With Low Back Pain. A General Approach Is As Effective As A Specific One. A Randomised Controlled Trial

ABSTRACT Background: Spinal manipulation is commonly used to treat back pain. The application of spinal manipulation has traditionally involved an element of targeting the technique to a level of the spine where the proposed movement dysfunction is sited. We evaluated the effects of a targeted manipulative thrust versus a thrust applied generally to the lumbar region. Methods: A randomised controlled clinical trial in patients with low back pain following CONSORT guidelines. Sixty subjects were randomly allocated to two groups—one group received a targeted manipulative thrust (TT) (n=29) and the other a general manipulation thrust (GT) (n=31) to the lumbar spine. Thrust was either localised to a clinician-defined symptomatic spinal level or an equal force was applied through the whole lumbo-sacral region. We measured pressure-pain thresholds (PPT) using algometry and muscle activity (magnitude of stretch reflex) via surface electromyography (EMG). Numeric ratings of pain and Oswestry disability index scores were collected. Results: Repeated measures of analysis of covariance (ANCOVA), revealed no between group differences in self-reported pain or pressure-pain threshold for any of the muscles studied. Summary: A general thrust procedure--applied without any specific targeting--was as effective in reducing participants’ pain scores as targeted approaches.