Vosboukas, D, Puniello, M, Watkins, M; MGH Institute of Health Professions, Boston, MA. mpuniello@mghihp.edu.

PURPOSE: To assess the short-term effects of the addition of lumbar spinal mobilization to conventional exercise treatment in patients with mechanical low back pain. SUBJECTS: Twenty-six subjects with mechanical low back pain participated and were divided into two groups: twelve received conventional exercise treatment, and fourteen received conventional exercise treatment plus spinal mobilization. METHODS: Subjects were seen a total of five visits over 3 weeks. Treatment was administered by the same physical therapist (DV), and consisted of ultrasound, soft tissue massage and therapeutic exercise. Exercises were chosen based on a decision algorithm that took into consideration the subject’s individual impairments, and consisted of flexibility, mobility and stability exercises. The mobilization group received the same intervention with the addition of spinal mobilization.Outcome measures were: pain using a visual analog scale; disability using the Roland Morris Disability Questionnaire; and Range of Motion (ROM) measurements using the modified Schober method, the fingertip to floor measurement for lateral side bending, and functional axial rotation utilizing a hoop-type device. Statistical analyses were performed using t-tests, and t-tests with Bonferroni correction. RESULTS: The mobilization group had a significant decrease in pain scores over four and five visits. Disability scores improved more in subjects that received spinal mobilization (improvement of 3.6 points for the mobilization group, and 1.6 points for the exercise group), however there were no statistically significant differences between groups. There were no significant differences between groups for any of the ROM measurements. CONCLUSIONS: The addition of spinal mobilization to conventional exercise intervention resulted in improved pain and disability scores. The selected ROM tests may not be sensitive enough to demonstrate a change over five visits. Patients with mechanical low back pain may benefit from a combined program utilizing lumbar spinal mobilization and therapeutic exercise. FUNDING SOURCE: None.

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