RELATIVE EFFECTIVENESS OF AN EXTENSION PROGRAM AND A COMBINED PROGRAMOF MANIPULATION AND FLEXION AND EXTENSION EXERCISES IN PATIENTS WITH ACUTE LOW-BACK SYNDROME

Background and Purpose. The relative effectiveness of an extension pro gram and a manipulation program with flexion and extension exercises w as examined in patients with low back syndrome. Subjects. Forty-nine p atients with less than a 3-month history of low back pain were seen at physical therapy clinics in western Pennsylvania, southern Mississipp i, and eastern Missouri during a 6-month period. Twenty-seven of the 4 9 patients were classified a priori into a treatment-oriented category of extension/mobilization and were then randomly assigned to particip ate in an extension program or a program of manipulation followed by h and-heel rocks (flexion and extension). Two patients dropped out of th e study (1 patient returned to work, and the other patient was unable to comply with the treatment schedule), and 1 patient was eliminated f rom 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 physic al therapists participated in the study. Methods. A randomized clinica l trial comparing the two regimens was conducted for a 1-week period. Outcome was assessed using an Oswestry Low Back Pain Questionnaire ini tially (before treatment) and at 3 and 5 days posttreatment, and data were analyzed using a 2 x 3 (group x time) analysis of variance. Resul ts. A significant interaction of the group and time variables was demo nstrated, indicating that the rate of positive response was greater in the manipulation/hand-heel rock group than in the extension group. Co nclusion and Discussion. In this category of patients with low back pa in, the use of manipulation as an adjunct to an ongoing exercise progr am appears to be warranted.