• Ronaldo Fernando de Oliveira, Richard Eloin Liebano, Lucíola da Cunha Menezes Costa, Lívia Leticia Rissato, and Leonardo Oliveira Pena Costa.
• Universidade Cidade de São Paulo, São Paulo, Brazil.
• Phys Ther. 2013 Jun 1;93(6):748-56.

BackgroundManual therapists typically advocate the need for a detailed clinical examination to decide which vertebral level should be manipulated in patients with low back pain. However, it is unclear whether spinal manipulation needs to be specific to a vertebral level.ObjectiveThe purpose of this study was to analyze the immediate effects of a single, region-specific spinal manipulation defined during the clinical examination versus a single non-region-specific spinal manipulation (applied on an upper thoracic vertebra) in patients with chronic nonspecific low back pain for the outcome measures of pain intensity and pressure pain threshold at the time of the assessment.DesignThis was a 2-arm, prospectively registered, randomized controlled trial with a blinded assessor.SettingThe study was conducted in an outpatient physical therapy clinic in Brazil.PatientsThe study participants were 148 patients with chronic nonspecific low back pain (with pain duration of at least 12 weeks).RandomizationThe randomization schedule was generated by an independent statistician and was concealed by using consecutively numbered, sealed, opaque envelopes.InterventionsA single high-velocity manipulation was administered to the upper thoracic region of the participants allocated to the non-region-specific manipulation group and to the painful lumbar levels of the participants allocated to the region-specific manipulation group.MeasurementsPain intensity was measured by a 0 to 10 numeric pain rating scale. Pressure pain threshold was measured using a pressure algometer.LimitationsIt was not possible to blind the therapist and participants.ResultsA total of 148 patients participated in the study (74 in each group). There was no loss to follow-up. Both groups improved in terms of immediate decrease of pain intensity; however, no between-group differences were observed. The between-group difference for pain intensity and pressure pain threshold were 0.50 points (95% confidence interval=-0.10 to 1.10) and -1.78 points (95% confidence interval=-6.40 to 2.82), respectively. No adverse reactions were observed.ConclusionThe immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region-specific versus non-region-specific manipulation techniques in patients with chronic low back pain.

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