Regional manual therapy and motor control exercise for chronic low back pain: a randomized clinical trial

Objectives: Clinical practice guidelines recommend a focus on regional interdependence for the management of chronic low back pain (CLBP). This study investigated the additive effect of regional manual therapy (RMT) when combined with standard physical therapy (SPT) in a subgroup with CLBP. Methods: Forty-six participants with CLBP and movement coordination impairments were randomly assigned to receive SPT consisting of a motor control exercise program and lumbar spine manual therapy, or SPT with the addition of RMT to the hips, pelvis, and thoracic spine. Outcome measures included disability level, pain intensity, pain catastrophizing, fear avoidance beliefs, and perceived effect of treatment. Appropriate parametric and non-parametric testing was used for analysis. Results: Both groups demonstrated improvements in disability level, pain intensity, pain catastrophizing, and fear avoidance beliefs across time (P < 0.001). There was no difference between groups for any variable over 12 weeks, although a significantly greater proportion of participants in the RMT group exceeded the minimal clinically important difference (MCID) for disability. The perceived effect of treatment also was significantly higher in the group receiving RMT at two weeks and four weeks, but not 12 weeks. Discussion: SPT with or without RMT resulted in significant improvements in disability level, pain intensity, pain catastrophizing, and fear avoidance beliefs over 12 weeks in persons with CLBP and movement coordination impairments. RMT resulted in greater perceived effect of treatment, and a clinically meaningful improvement in disability, across four weeks compared to SPT alone. Level of Evidence: 1b Clinical Trial Registration: ClinicalTrials.gov registration No. NCT02170753.