The biomechanical and analgesic effects of lumbar mobilisations

This research set out to establish the biomechanical and analgesic effects of longer durations of lumbar mobilisations than commonly used in clinical practice. Only the immediate effects of a single treatment dose have been assessed to date.

Project aims

Three studies were conducted.

Firstly a reliability study (n=20) was undertaken to ensure the reliability of pressure pain thresholds (PPT), ROM, and stiffness measurements of the lumbar spine. Two methods of stiffness measurement were identified from the literature; in this study measurements were simultaneously collected using both methods to allow comparison. Excellent reliability PPT, good reliability for ROM and moderate reliability for both stiffness measurements were established. Standard error of measurement (SEM) and Minimal Detectable change (MDC) statistics were calculated to enable identification of participants who responded to treatment in the later studies.

Secondly, a single-arm trial (n=17) was conducted to determine the immediate effects of three and six minutes of lumbar spine mobilisations on ROM, stiffness and pain (PPT) and verbal rating scales (VRS) of pain in participants with LBP. 

Finally a randomised placebo controlled trial (n=72) was conducted to establish the immediate and short-term (24 hours after treatment) analgesic effects of different duration of lumbar mobilisation in participants with LBP. Two groups (short and long duration) were included in the study. Analysis of treatment responders demonstrated that significantly more participants receiving longer duration of treatment experienced a reduction in PPT local to the site of treatment. There was no overall difference between treatment groups. Verbal rating of pain on movement was significantly reduced after treatment but the difference between treatment groups failed to reach significance. 

Project findings

In the single arm trial, verbal rating of pain on movement there was a significant difference between durations, with a significant reduction in pain immediately after six minutes of treatment, but not after three minutes of treatment. There was a significant increase in PPT (p<.01) immediately following both durations of treatment. The difference between three and six minutes of treatment on PPT failed to reach significance. These findings suggest that three minutes of mobilisation treatment were not sufficient to create a significant change in PPT. There was no significant change in ROM (p=0.42) or stiffness (p=0.11- p=0.99) following either duration of treatment.

In the randomised placebo controlled trial, analysis of treatment responders demonstrated that significantly more participants receiving longer duration of treatment experienced a reduction in PPT local to the site of treatment. There was no overall difference between treatment groups. Verbal rating of pain on movement was significantly reduced after treatment but the difference between treatment groups failed to reach significance. 

Research team

Clair Hebron

Professor Ann Moore

Dr Kambiz Saber-Sheikh

Dr Anne Jackson  (School of Pharmacy and Biomolecular Sciences)

Output

Publications

Pentelka,L., Hebron, C., Shapleski, R., Goldshtein, I. (2012)The effect of increasing sets (within one treatment session) and different set durations (between treatment sessions) of lumbar spine posteroanterior mobilisations on pressure pain thresholds. Manual Therapy, 17, 6, 526-530.

Krouwel O, Hebron, C, Willett E (2009) An Investigation into the Potential Hypoalgesic Effects of Different Amplitudes of PA Mobilisations on the Lumbar Spine as Measured by Pressure Pain Thresholds (PPT). Manual Therapy, 15,1 7-12.

Willett E, Hebron C, Krouwel O.(2009) The Initial Effects of different rates of Lumbar Mobilisations on Pressure Pain Thresholds in asymptomatic subjects  Manual Therapy, 15, 2, 173-178.

Poster presentations

Hebron, C., Moore, A., Saber-Sheikh, K., Jackson, A. (2012). The immediate effects of 3 and 6 minutes of lumbar mobilisations on pain, ROM and stiffness in patients with low back pain: IFOMPT, the World Congress of Manual/Musculoskeletal Physiotherapy. September 30 to October 5, Quebec City, Canada.

Krouwel O and Hebron C. An Investigation into the Potential Hypoalgesic Effects of Different Amplitudes of PA Mobilisations on the Lumbar Spine as Measured by Pressure Pain Thresholds (PPT). 7th Interdisciplinary World Conference on Low Back and Pelvic Pain. 9th -12th November  2010, Los Angeles, USA.

Conference presentations

Hebron, C., Moore, A., Saber-Sheikh, K., Jackson , A. (2012). A comparison of three-point bending and displacement methods of stiffness measurements in the lumbar spine: IFOMPT, the World Congress of Manual/Musculoskeletal Physiotherapy. September 30 to October 5, Quebec City, Canada.

Pentelka,L., Hebron, C., Shapleski, R., Goldshtein, I. (2012). The effect of increasing sets (within one treatment session) and different set durations (between treatment sessions) of lumbar spine posteroanterior mobilisations on pressure pain thresholds:  IFOMPT, the World Congress of Manual/Musculoskeletal Physiotherapy. September 30 to October 5, Quebec City, Canada.

Pentelka L, Hebron C, Shapleski R. The effect of different durations of lumbar spine posteroanterior mobilisations on pressure pain thresholds. The 11th Israel National Physiotherapy Conference: 17th May 2011, Airport City, Israel.

Willett E and Hebron C. The Initial Effects of different rates of Lumbar Mobilisations on Pressure Pain Thresholds in asymptomatic subjects. Society of Back Pain Research: 6th and 7th November 2008, Keele, UK.

Willett E and Hebron C. The Initial Effects of different rates of Lumbar Mobilisations on Pressure Pain Thresholds in asymptomatic subjects.  KC/MACP Conference: 30th October -1st November 2009, Edinburgh, UK.

Willett E and Hebron C. The Initial Effects of different rates of Lumbar Mobilisations on Pressure Pain Thresholds in asymptomatic subjects.  ACPSM Conference: Belfast 2008.

Partners

Dr Anne Jackson (School of Pharmacy and Biomolecular Sciences)