This double-blind, randomized study assessed the effectiveness of physiotherapy instrument mobilization (PIM) in patients with low back pain (LBP) and compared it with the effectiveness of manual mobilization.
Thirty-two participants with LBP were randomly assigned to one of two groups:
- The PIM group received lumbar mobilization using an activator instrument, stabilization exercises, and education.
- The manual group received lumbar mobilization using a pisiform grip, stabilization exercises, and education.
Both groups had 4 treatment sessions over 2-3 weeks. The following outcomes were measured before the intervention, and after the first and fourth sessions:
- Numeric Pain Rating Scale (NPRS),
- Oswestry Disability Index (ODI) scale,
- Pressure pain threshold (PPT),
- lumbar spine range of motion (ROM),
- lumbar multifidus muscle activation.
There were no differences between the PIM and manual groups in any outcome measures. However, over the period of study, there were improvements in both groups in NPRS (PIM: 3.23, Manual: 3.64 points), ODI (PIM: 17.34%, Manual: 14.23%), PPT (PIM: ⩽ 1.25, Manual: ⩽ 0.85 kg.cm2), lumbar spine ROM (PIM: ⩽ 9.49∘, Manual: ⩽ 0.88∘), and/or lumbar multifidus muscle activation (percentage thickness change: PIM: ⩽ 4.71, Manual: ⩽ 4.74 cm; activation ratio: PIM: ⩽ 1.17, Manual: ⩽ 1.15 cm).
The authors concluded that both methods of lumbar spine mobilization demonstrated comparable improvements in pain and disability in patients with LBP, with neither method exhibiting superiority over the other.
If this conclusion is meant to tell us that both treatments were equally effective, I beg to differ. The improvements documented here are consistent with improvements caused by the natural history of the condition, regression towards the mean, and placebo effects. The data do not prove that they are due to the treatments. On the contrary, they seem to imply that patients get better no matter what therapy is used. Thus, I feel that the results are entirely in keeping with the hypothesis that spinal mobilization is a placebo treatment.
So, allow me to re-phrase the authors’ conclusion as follows:
Lumbar mobilizations do not seem to have specific therapeutic effects and might therefore be considered to be ineffective for LBP.
5 Responses to More evidence to suggest that spinal mobilizations for low back pain are ineffective
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There is no “Low Back Pain” entity. This is a mere construct of laziness and incompetence on the part of those making this “diagnosis”. Due to the lack of a concept for the systemic analysis of the musculoskeletal system, people mess around at the site of the complaint, some with painkillers, others with manual spinal manipulation, which often does more harm than good.
depends what you mean by ‘entity’;
LBP is a symptom, that’s all.
The most recent Cochrane review of SMT further downgraded an earlier poor review to conclude nil effects. It’s difficult to see at this point that anyone would still be trying to justify SMT especially given known serious risks. Thank you Edzard, so important to keep getting the message out there.
This study wasn’t on SMT. It was grade III mobilization.
If they followed the protocols as explained in the clinical trial registry:
https://clinicaltrials.gov/ct2/show/NCT04367376
I would concur that both are most likely placebos. All they did was use a low force to push on subjects backs in the P to A direction. Subjects that could have been anywhere from acute to chronic.