Immediate Effects of a Spinal Lumbar Manipulation
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Non-specific low back pain is defined as a pain with no specific vertebral-related cause,
      such as infectious disease, tumor, osteoporosis, fracture, structural abnormality,
      inflammatory disease, radicular compressive syndrome or cauda equine syndrome. Non-specific
      low back pain is a common disease in many countries. This musculoskeletal disorder is costly
      to public health systems. Therefore, the use of manual therapies is important in the
      treatment of this disease and studies show the effectiveness of this type of therapy.

      Spinal manipulation is applied in manual therapies such as Osteopathy, Chiropractic and
      Physical Therapy and is widely used for acute and chronic non-specific low-back pain. There
      is moderate evidence that spinal manipulation is superior to sham spinal manipulation for
      improving short-term pain and function in chronic and acute non-specific low back pain.
      However the therapeutic mechanisms involved in this procedure are not well understood.
      Furthermore, while the high velocity and low amplitude spinal therapy has been shown to be
      effective in reducing pain and improving functional capacity in subjects with non-specific
      low back pain, the effect on postural variables have not been investigated. Therefore, the
      aim of this study is to evaluate the acute effect of lumbar manipulation on pain and postural
      variables.

      Twenty-four individuals with non-specific low back pain will be randomly allocated to two
      groups. The intervention group will receive high velocity and low amplitude spinal therapy,
      while the control group will receive sham manipulation. Immediately before and after the
      respective manipulation protocol, both groups will be evaluated regarding pain level, using a
      visual-analogue scale and algometer, and postural variables, using center of pressure
      displacement measured with the aid of a force plate. While the patient and therapist
      manipulator will be aware of the protocol applied in each case, the evaluator will be blind.
      A statistical treatment will be used to compare the results.
    

Detailed description: 
      Mean and standard deviation are calculated for each variable of postural control, as well as
      the values obtained in the measurement of pain using the numeric pain rating scale and
      algometry data.

      t-test or Mann-Whitney test will be used to compare data before and after the manipulation
      protocol.

      Multiple One-Way ANOVAs will be used to compare the manipulation protocol, for each dependent
      variable: effects of pain and center of pressure displacement.. Statistical analysis will be
      conducted with a confidence interval of 95%, α value of 5%, p value of ≤ 0.05.
    

Intervention name(s): HVLA Manipulation
Intervention type(s): Other
Intervention description(s): Intervention Group who receives a high velocity and low amplitude (HVLA) lumbar manipulation. A manual procedure also known as high velocity and low amplitude lumbar spinal manipulation are delivered for the subjects in the side lying position. The lumbar segment more restrict (mobility restriction) will be the target region for the manipulative procedure.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: non-specific low back pain; center of pressure; spinal lumbar manipulation; high velocity and low amplitude manipulation; postural control