Welcome back! I don’t have much to say this week except sorry for the double email last week. And welcome to new subscribers Seth K., Marsha A., Jasper B., and more. Hello!
The best things I read this week? Well, I haven’t really read anything this week except these studies. It’s summer and I’ve gotten in about 12 hours of cycling in the last 5 days so I’m having a grand old time. Hope all is well for you and yours and (as always) feel free to get in touch by replying to this email.
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With that, let’s dive in!
Just Push Anywhere - Generic Vertebral Manips are Equal to Directed Manips in Chronic LBP
The Gist - This study from the Journal of Physiotherapy assessed two different styles of vertebral manips, directed and generic. Building on previous research that showed that generic manips were equal to directed ones in one treatment, the researchers checked out how a long term treatment program with only generic manips would work. What’s a direct vs generic manipulation? A PT applied P-A vetebral pressure at each spinal level, and the patient told them where it was most symptomatic. In the direct manipulation group, that level was then selected for manipulation. In the generic manip group, they went through the same pain ID process, then had manips done in the mid-thoracic (T5 or T6). Patients had a total of ten treatments over the course of four weeks, then were assessed at weeks 4, 12, and 26.
Pain intensity was the primary measure, and they also used a disability scale to measure against. Total, there were 148 patients in the study and the pain differences at weeks 4, 12, and 26 were all within 0.1 points, very not clinically significant. Almost exactly the same! So manips at the most painful level or mid-thoracic caused the same pain reduction.
Tell Me More - The big question you’re probably asking is “why does this matter?” The study authors assess that as well. Since there are no clinically important differences in pain, disability (according to the Roland Morris Disability Questionnaire) or Global Perceived Effect between the two techniques, it allows the PT to choose where to manip without sacrificing treatment efficacy. According to the study authors:
Based on the results of this trial, the therapist may choose his/her preferred therapy: non-specific or specific manipulation. In the case of patients with severe low back pain, for example, the therapist’s decision would be to manipulate a site away from the painful segment. Also, the therapist’s ability with either technique may be considered. Therapists may choose to manipulate the patient specifically at the most affected level or not, according to the technique in which he/she is most skilled and has the most experience.
They go a bit deeper on this analysis in the whole paper as well, so check that out if you’re looking for more reasons why it matters.
The big remaining questions are: 1) Why are these techniques the same? and 2) What are the weaknesses? The big answers are: 1) We don’t really know but we think that it’s because the lumbar and thoracic regions are interdependent, so this is like treating the thoracic spine to help with neck pain and 2) the therapist wasn’t blinded to the technique used (because, how?). Overall, really interesting study that opens up new avenues in treating complex patients.
Alright, where’s that paper? Right here!
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Here’s the deets on the article from this week:
- de Oliveira, R. F., Costa, L. O. P., Nascimento, L. P., & Rissato, L. L. (2020). Directed vertebral manipulation is not better than generic vertebral manipulation in patients with chronic low back pain: A randomised trial. Journal of Physiotherapy. https://doi.org/10.1016/j.jphys.2020.06.007