Spinal Mobilisation for Low Back Pain

This thesis reports a series of studies investigating the use of one form of spinal manipulative therapy: mobilisation treatment for low back pain. A number of treatment dose parameters such as ‘force characteristics’, ‘spinal level treated’ and ‘mobilisation technique used’ have been investigated in order to gain a better understanding of mobilisation treatment. The first study describes the development and evaluation of an instrumented plinth (called the Sydney Instrumented Plinth or SIP) capable of measuring the forces used during manual treatment (Chapter 2). The SIP was found to be highly reliable in measuring forces in three directions. Importantly, the SIP measures the force-time data without interfering with the normal treatment protocol and is portable enough to permit data collection in treatment clinics

Efficacy of “therapist-selected” versus “randomly selected” mobilisation techniques for the treatment of low back pain: A randomised controlled trial

The aim of this study was to establish whether the mobilisation technique selected by the treating physiotherapist is more effective in relieving low back pain than a randomly selected mobilisation technique. Two manipulative physiotherapists and 140 subjects suffering non-specific low back pain participated. Baseline measurements were taken before treatment allocation; the therapist then assessed subjects and nominated the preferred treatment grade, spinal level to be treated and mobilisation technique to be used. The subjects were then randomly allocated to one of two groups. One group received the preferred mobilisation technique as selected by the therapist; the other group received a randomly assigned mobilisation technique. All mobilisation treatments were applied to the nominated spinal level using the nominated treatment grade. Follow-up measures were taken immediately after intervention. Two-way ANOVA was used to analyse the data; the first factor was the treatment group and the second factor was the direction of the patient's most painful movement. The choice of mobilisation treatment had no effect on any outcome measure investigated in this study; however, post hoc tests revealed that mobilisation treatment applied to the lower lumbar levels had a greater analgesic effect than when applied to upper lumbar levels. The results of this study confirm that lumbar mobilisation treatment has an immediate effect in relieving low back pain, however the specific technique used seems unimportant