The Effect of Lumbopelvic Non-Thrust Spinal Manipulation on Individuals With Low Back Pain

Study Overview
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Brief Summary
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The purpose of this experiment is to determine the effects of a non-thrust manipulation procedure on muscle function, spinal mobility, and pain level on those experiencing low back pain (LBP) in a sample of individuals who identify English as their primary language. The rationale for this language criterion is provided in Section 9:F of this application. Muscle function will be measured via the muscle thickness of a deep spinal stabilizing muscle (multifidus, MF) while in both a resting state and during a maximum voluntary contraction (MVC). Spinal mobility will be measured as the active range of motion of both forward and backward trunk bending. Pain level will be a self-report measure recorded during rest and active range of motion. Hypothesis 1: A non-thrust manipulation procedure will increase the thickness of the sacral multifidus both at rest and during a maximum voluntary contraction Hypothesis 2: A non-thrust manipulation procedure will result in greater low back active range of motion. Hypothesis 3: A non-thrust manipulation procedure will result in a reduction in the participant's self-reported pain levels both at rest and during active range of motion movements.

Detailed Description
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The proposed study aims to determine if the impact of a newly-described manual procedure, that includes a non-thrust force applied to the low back region, has an impact on patient centered-outcomes. Rehabilitation Ultrasound Imaging (RUSI) will be used to determine MF muscle thickness (MT) at rest and during a maximum voluntary contraction (MVC) immediately following application of the manual procedure.

Official Title
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The Effect of Lumbopelvic Non-Thrust Spinal Manipulation on Muscle Thickness of the Sacral Multifidi, Lumbar Motion, and Self-Reported Pain

Conditions
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Low Back Pain

Intervention / Treatment
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* Other: Lumbar Spine Manipulation
* Other: Sham Manipulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants are individuals with current complaint of low back pain, defined as pain that is present in the region from just below the rib cage to just below the buttocks. Participants will be 18 years of age or older Participants must be experiencing an episode of low back pain at the present time that is at any level on a Numerical Pain Rating Scale & Pain Diagram (NPRS) from 1-10 Participants must demonstrate the ability to maintain standing and prone postures for several minutes at a time and perform lumbar active range of motion in a standing position Participants must report the presence of their low back pain during performance of active forward and/or backward bending in standing Participants must demonstrate the ability to communicate in conversational English, that includes speaking, reading, and writing. Exclusion Criteria: Participants who are currently involved in litigation that is directly related to the participant's current episode of low back pain Participants with known or suspected pregnancy Participants with confirmed diagnosis of any of the following conditions: Central nervous system disorder Rheumatoid Arthritis Spinal Fracture Spondyloarthropathy (i.e., Ankylosing Spondylitis) Tumor or infection of the spine

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lumbar Manipulation Group<br>Group that receives experimental lumbar non-thrust manipulation | Other: Lumbar Spine Manipulation<br>* Lumbar non-thrust manipulation is a passive movement that is performed with a rhythm and a grade in a manner in which the patient is able to prevent the technique from being performed.<br>|
| Sham Comparator: Sham Manipulation Group<br>Group that receives sham lumbar non-thrust manipulation | Other: Sham Manipulation<br>* Lumbar non-thrust manipulation without force applied<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Sacral Multifidus Muscle Thickness | Rehabilitation Ultrasound Images of Sacral Multifidus muscle thickness at rest and during a maximal isometric contraction | Change from Pre to immediately Post Manipulation/Sham | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Lumbar Active Range of Motion | Inclinometry of Lumbar Active Range of Motion in Standing | Change from Pre to immediately Post Manipulation/Sham | 
| Changes in Low Back Pain | Visual Analogue Scale of Low Back Pain (0-10 scale with 0=least pain, 10=worst pain) | Change from Baseline to immediately Post Manipulation/Sham to 24-48 hours post session | 
| Changes in Oswestry Disability Questionnaire (0-100 scale, 0=no disability, 100=bed bound, exaggerating symptoms) | Self-assessment disability paper survey | Change from Baseline to 24-48 hours post session | 
| Changes in Fear-Avoidance Beliefs Questionnaire (0-96, 96=maximum fear-avoidance beliefs) | Self-assessment disability paper survey | Change from Baseline to 24-48 hours post session | 
| Changes in Global Rating of Change (-7 to +7 scale, -7=a very great deal worse, +7=a very great deal better) | Self-assessment disability paper survey | Change from Baseline to 24-48 hours post session |