Lumbar Manipulation in Lumbar Hypomobility
Condition: Hypomotility; Lumbar Spine Instability
Study type: Interventional

Summary: 
      The purpose of the study is to compare the immediate effects of thrust versus non-thrust
      lumbar manipulation in individuals with lumbar hypo-mobility on lumbar range of motion and
      springing force tolerance. A randomized control trial was conducted at Max Rehab and Physical
      Therapy Centre, Islamabad. The sample size was 18 calculated through open-epi tool but I
      recruited 60. The participants were divided into two interventional groups each having 30
      participants. The study duration was six months. Sampling technique applied was Purposive
      sampling for recruitment and group randomization using flip coin method. Only 20 to 35 years
      participants with grade one or two hypo-mobility at lumbar region were included in the study.
      Tools used in this study are Goniometer, Inclinometers (lumbar Inclinometry using dual
      inclinometer method),Digital Algometer, Self structured Questionnaire. Data was collected
      before and immediately after the application of interventions. Data analyzed through SPSS
      version 23.
    

Detailed description: 
      A systematic and evidence based search of relevant literature was performed by utilizing
      PubMed and Google Scholar as search engines and the key words used were lumbar manipulation,
      hypo-mobility, spinal stiffness, non-thrust manipulation, lumbar mobilizations,
      segmentalstiffness.The purpose of the literature review is to find out the pre-existing
      literature regarding the Lumbar mobilizations and TJM interventions for Lumbar Hypomobility.

      In 2019 a systematic review conducted by Aoyagi et al on effectiveness of spinal mobilization
      stated that there is a moderate to high quality evidence on Spinal mobilizations as effective
      intervention in low back pain as it decreases pain and improve Range of motion In 2019,a
      systematic review conducted by Hofstetter et al on Instrumented measurement of spinal
      stiffness stated that mechanical devices revealed excellent reliability tool to measure
      Spinal stiffness especially in prone position.

      In 2019, a systematic review and meta-analysis conducted by a chi Ngai Lo et al on Spinal
      manipulation stated that HVLAT is highly effective as an treatment protocol then no
      intervention or sham manipulation because it improves muscle strength in healthy population
    

Intervention name(s): Thrust joint lumbar manipulation; Lumbar mobilization
Intervention type(s): Other; Other
Intervention description(s): Moist Hot pack of 14/15' over lumbar region for 15 mins. Hydro collator Temperature according to standardized hot pack is 40-45οC.Bilateral Thrust Manipulation of Lumbar Spine from L1-L5 Baseline Algometer for springing force tolerance and Lumbar Inclinometry using dual inclinometer for lumbar flexion, extension and goniometer for lumbar side bending.These pre and post intervention values were mentioned in questionnaire. The participants were administered with thrust and non-thrust manipulation of the lumbar spine and data was collected again immediately after the interventions without any delay.; Moist Hot pack of 14/15' from L1 where ribcage ends up to the region of gluteal folds for 15 mins. Non Thrust Manipulation for 30 seconds Using Kaltenborn grade 3 (Stretch rotation mobilization).Baseline Algometer for springing force tolerance and Lumbar Inclinometry using dual inclinometerfor lumbar flexion, extension and goniometer for lumbar side bending. These pre and post intervention values were mentioned in questionnaire. The participants were administered with thrust and non-thrust manipulation of the lumbar spine and data was collected again immediately after the interventions without any delay.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Lumbar Mobilization; Hypo-mobility; Spinal or segmental stiffness; Lumbar Manipulation