PAST ISSUES OF THE JOURNAL OF MANUAL AND MANIPULATIVE THERAPY

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2003 - Vol. 11, No. 2


Chronic Low Back Pain: A Critical Review of Specific Therapeutic Exercise Protocols on Musculoskeletal and Neuromuscular Parameters

Cheryl L. Hubley-Kozey, BPE, MSc, PhD, Tracey A. McCulloch, MSc, David H. McFarland, PhD

Abstract: Although exercise is often used in the treatment of chronic non-specific low back pain, little is known about the efficacy of specific exercises on the physiological or structural processes underlying this form of back pain. We evaluated the current published studies that used specific exercise interventions for non-specific low back pain and that utilized strength, endurance, neuromuscular control, flexibility, or posture as primary outcome variables. Our review revealed that 11 different control trials fit our criteria (15 published papers), with the majority evaluating strengthening protocols (N=13). Moderate evidence indicates that specific exercises improve abdominal and trunk extensor strength and endurance, while minimal evidence supports improvements in neuromuscular control characteristics, posture, spinal motion, or muscle tissue characteristics. Most studies reported improvements in both functional daily activities as well as an accompanying reduction in low back pain. We concluded that more thorough investigations utilizing better diagnostic classifications are needed to determine whether specific exercise protocols produce the desired effects on neuromuscular control impairments as well as on the mechanical environments that have been shown to contribute detrimentally to low back pain.


The Journal of Manual & Manipulative Therapy Vol. 11 No. 2 (2003), 78 - 87


Joining Forces - Combining Cognition-Targeted Motor Control Training with Group or Individual Pain Physiology Education: A Successful Treatment for Chronic Low Back Pain

G. Lorimer Moseley, PhD

Abstract: Chronic unremittent low back pain (LBP) is characterised by cognitive barriers to treatment. Combining a motor control training approach with individualised education about pain physiology is effective in this group of patients. This randomized comparative trial (i) evaluates an approach to motor control acquisition and training that considers the complexities of the relationship between pain and motor output, and (ii) compares the efficacy and cost of individualized and group pain physiology education. After an "ongoing usual treatment" period, patients participated in a 4-week motor control and pain physiology education program. Patients received four one-hour individualized education sessions (IE) or one 4-hour group lecture (GE). Both groups reduced pain (numerical rating scale) and disability (Roland Morris Disability Questionnaire). IE showed bigger decreases, which were maintained at 12 months (P < 0.05 for all). The combined motor control and education approach is effective. Although group education imparts a lesser effect, it may be more cost-efficient.


The Journal of Manual & Manipulative Therapy Vol. 11 No. 2 (2003), 88 - 94


A Randomized Trial Comparing Interventions in Patients with Lumbar Posterior Derangement

Ronald J. Schenk, PT, PhD, OCS, FAAOMPT, Cherie Jozefczyk, MS, PT, Aric Kopf, MS, PT

Abstract: This pretest/posttest study compared the outcomes of people with low back pain who were treated with exercises or joint mobilization. Thirty-one patients referred to physical therapy with a physician's diagnosis of lumbar radiculopathy were initially recruited as subjects. All 31 patients were examined and treated by a physical therapist with 17 years of clinical experience. Following the initial examination, those subjects classified into the derangement category (n=25) were randomly assigned to a group that received joint mobilization (n=10) or a group that performed therapeutic exercises as described by the McKenzie method (n=15). The remaining six patients were not classified into the derangement category and were not included in the analysis. The subjects were also classified according to the Quebec Task Force (QTF) system. The patient's pain as reported on the verbal analog scale and the patient's perceived level of function as indicated by Oswestry scores were recorded at the initial evaluation and following the third physical therapy visit. The McKenzie group performed exercises that were based on their response to repeated movements and the mobilization group received manual techniques based on active and passive movements and passive intervertebral motion testing. All subjects were instructed in postural correction. Data were analyzed through the use of t-tests and correlation coefficients. Subjects who performed therapeutic exercise were found to have significantly greater decreases in pain level (p<.01) and significantly greater improvement in function (p<.03) as compared to the mobilization group. Low correlations were found between the QTF classification and the outcome measures. The results indicated that exercises based on repeated movements might be more beneficial in terms of pain reduction and recovery of function than joint mobilization in the early stages of recovery from lumbar disc derangement. The results also point toward the importance of including repeated movements as part of the lumbar evaluation to assist in the prescription of appropriate therapeutic exercise.


The Journal of Manual & Manipulative Therapy Vol. 11 No. 2 (2003), 95 - 102


Use of Multifidus Isometric for a Patient with Acute Neck Pain: A Case Report

James A. Viti, PT, DPT, OCS, FAAOMPT, Stanley V. Paris, PhD, PT, FAPTA

Abstract: The purpose of this case report is to describe how a simple isometric technique was effective in treating a patient with complaints of acute neck pain. The patient was a 35-year-old female who complained of an acute onset of right cervical pain. She exhibited a significant increase in range of motion (approximately 50 degrees of right rotation) and a 50% reduction in pain level after one treatment. After two treatments, full pain-free cervical range of motion and function was restored. The report suggests that the technique can significantly increase cervical range of motion and decrease pain in one treatment session. Thrust and nonthrust manipulation techniques have been found to be effective in treating neck pain. Nonthrust techniques, however, appear to lessen the risk to the patient. The multifidus isometric is a safe, nonthrust manual therapy technique that can be effective in reducing pain and increasing range of motion in some cases of acute cervical dysfunction in as little as one treatment session.


The Journal of Manual & Manipulative Therapy Vol. 11 No. 2 (2003), 103 - 109


McGill Pain Questionnaire Scores Do Not Predict Outcomes of Outpatient Therapy for Patients with Low Back Pain

John R. Zogaria, MSc, PT, OTR, Richard W. Bohannon, EdD, PT, NCS

Abstract: The purpose of this study was to determine the value of the McGill Pain Questionnaire (MPQ) as a predictor of two outcomes in patients receiving outpatient physical therapy services. The outcomes of interest were the patients' final Oswestry Low-Back Pain Questionnaire (OLBPQ) score and the change between the patients' initial and final OLBPQ scores. Predictive validity of the MPQ was examined in the context of other potentially informative variables. Data from 23 patients with low-back pain were analyzed. Data obtained at enrollment included initial MPQ and OLBPQ scores, demographics, compensation status, time since onset, injury type, employment type, and worker class. MPQ scores predicted neither outcome. Initial OLBPQ scores and compensation status, however, predicted outcomes. Together these variables explained 59.1 percent of the variance in the final OLBPQ score and 46.3 percent of the variance in the change (improvement) in the OLBPQ score. Results of this study do not support use of the MPQ as a predictor of functional outcome in outpatients with low-back pain.


The Journal of Manual & Manipulative Therapy Vol. 11 No. 2 (2003), 110 - 116