Relative Effectiveness of an Extension Program and a Combined Program of Manipulation and Flexion and Extension Exercises in Patients With Acute Low Back Syndrome

Richard E Erhard, Anthony Delitto, Michael T Cibulka


Background and Purpose. The relative effectiveness of an extension program and a manipulation program with flexion and extension exercises was examined in patients with low back syndrome. Subjects. Forty-nine patients with less than a 3-month history of low back pain were seen at physical therapy clinics in western Pennsylvania, southern Mississippi, and eastern Missouri during a 6-month period. Twenty-seven of the 49 patients were classified a priori into a treatment-oriented category of extension/mobilization and were then randomly assigned to participate in an extension program or a program of manipulation followed by hand-heel rocks (flexion and extension). Two patients dropped out of the study (1 patient returned to work, and the other patient was unable to comply with the treatment schedule), and 1 patient was eliminated from the study because of magnified illness behavior. The remaining 24 patients (15 male, 9 female; mean age=44 years, SD=15, range=14–73) were assigned randomly and equally to the two groups. Eight physical therapists participated in the study. Methods. A randomized clinical trial comparing the two regimens was conducted for a 1-week period. Outcome was assessed using an Oswestry Low Back Pain Questionnaire initially (before treatment) and at 3 and 5 days posttreatment, and data were analyzed using a 2×3 (group×time) analysis of variance. Results. A significant interaction of the group and time variables was demonstrated, indicating that the rate of positive response was greater in the manipulation/hand-heel rock group than in the extension group. Conclusion and Discussion. In this category of patients with low back pain, the use of manipulation as an adjunct to an ongoing exercise program appears to be warranted.

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  • Received September 16, 1993.
  • Accepted July 8, 1994.