Lumbar Evidence

Manual therapy interventions for the lumbar spine have been associated with improvements in pain, function and disability in individuals with non-specific low back pain (LBP), lumbar spinal stenosis (LSS) and lumbosacral radicular syndrome (LRS).

Non-specific Low Back Pain (lbp):

"Defined by the American College of Physicians and American Pain Society as "pain that cannot be reliably attributed to a specific disease or spinal abnormality" and accounts for over 85% of patients with low back pain that present to primary care. This is due to the inability to validate specific anatomical sources as the cause of symptoms and the conflict in classification schemes based on specific anatomical abnormality currently present in the medical literature."  

• Chou, 2007, Ann Internal Med
• Flynn, 2002, Spine
• Childs, 2004, Ann Intern Med
• Assendelft, 2008, Cochrane Database Syst Rev
• Cleland, 2009, Spine
• Koppenhaver, 2010, J Orthop Sports Phys Ther
• Rubinstein, 2011, Cochrane Database Syst Rev

Lumbar Spinal Stenosis (lss):

There are currently no studies that have investigated the effect of manual therapy alone on clinical outcomes in individuals with LSS. There is one study that included lumbar spine manual therapy interventions in a comprehensive conservative treatment protocol for individuals with LSS. In this randomized controlled trial, subjects with LSS were randomized to receive one of two treatment programs. The experimental group received manual therapy interventions to the spine and lower extremities (as needed), exercise and body-weight supported treadmill walking. At 6 weeks, a higher percentage of the patients in the manual therapy/exercise/body weight support treadmill group demonstrated clinically meaningful recovery compared to patients in the flexion/ultrasound/walking group. Although between -group differences in clinical outcomes were no longer significant at one year, disability, treadmill walking times and satisfaction all favored the manual therapy/treadmill walking/exercise group.

• Whitman, 2006, Spine
• Pim, 2007, Eur Spine J
• Browder, 2007, Phys Ther
• Leininger, 2011, Phys Med Rehabil Clin N Am

Ankylosing Spondylitis (as):

There is very little evidence to suppor the use of manual therapy in the management of of patients with AS. An RCT with only 32 subjects with AS were randomized to receive clinician imparted mobilizations and self-mobilizations 1 hour twice a week in addition to an impairment-based home exercise program for a total of 8 weeks compared to a control group receiving no treatment.  At eight week follow-up, there were significantly better improvements in chest expansion, posture, and spine mobility in the manual therapy group.

• Rose, 2003, J Manipulative Physiol Ther
• Cleland, 2006, J Orthop Sports Phys Ther
• Stuber, 2009, J Chiropr Med
• Clinical Guideline Subcomittee on LBP: AOA, 2010, J Am Osteopath Assoc
• Senna, 2011, Spine

lumbar Spinal Stenosis

• Creighton, 2006, JMMT
• Backstrom, 2011, Manual Therapy

Ankylosing Spondylitis

• Widberg, 2009, Clin Rehabil
• Passalent, 2011, Curr Opin Rheumatol

Other Relevant Evidence:

• Powers, 2003, Clin Biomech
• Kulig, 2004, J Orthop Sports Phys Ther
• Raney, 2007, J Orthop Sports Phys Ther
• Landel, 2008, Phys Ther
• Grindstaff, 2009, Man Ther
• Fritz, 2011, Spine