The immediate reduction in low back pain intensity following lumbar joint mobilization and prone press-ups is associated with increased diffusion of water in the L5-S1 intervertebral disc.
METHODS
Single-group, prospective, repeated-measures design.


OBJECTIVE
To determine differences in the changes of diffusion of water in the L5-S1 intervertebral disc between subjects with nonspecific low back pain (LBP) who reported an immediate reduction in pain intensity of 2 or greater on an 11-point (0-10) numeric rating scale after a 10-minute session of lumbar joint mobilization, followed by prone press-up exercises, compared to those who did not report an immediate reduction in pain intensity of 2 or greater on the pain scale.


BACKGROUND
Combining lumbar joint mobilization and prone press-up exercises is a common intervention for patients with LBP; however, there is conflicting evidence regarding the effectiveness and efficacy of this approach. Increased knowledge of the physiologic effects of the combined use of these treatments, and the relationship to pain reports, can lead to refinement of their clinical application.


METHODS
Twenty adults, aged 22 to 54, participated in this study. All subjects reported LBP of at least 2 on an 11-point (0-10) verbally administered numeric rating scale at the time of enrollment in the study and were classified as being candidates for the combination of joint mobilization and prone press-ups. Subjects underwent T2- and diffusion-weighted lumbar magnetic resonance imaging scans before and immediately after receiving a 10-minute session of lumbar pressures in a posterior-to-anterior direction and prone press-up exercises. Subjects who reported a decrease in current pain intensity of 2 or greater immediately following treatment were classified as immediate responders, while the remainder were classified as not-immediate responders. The apparent diffusion coefficient, representing the diffusion of water in the nucleus pulposis, was calculated from the midsagittal diffusion-weighted images.


RESULTS
Following treatment, immediate responders (n = 10) had a mean increase in the apparent diffusion coefficient in the middle portion of the L5-S1 intervertebral disc of 4.2% compared to a mean decrease of 1.6% for the not-immediate responders (P<.005).


CONCLUSIONS
In a group of subjects with LBP, who were classified as being candidates for extension-based treatment, the report of an immediate reduction in pain intensity of 2/10 of greater after a treatment of posterior-to-anterior-directed pressures, followed by prone press-up exercises, was associated with an increase in diffusion of water in the nuclear region of the L5-S1 intervertebral disc. Subjects who did not report a pain reduction of at least 2/10 did not have a change in diffusion. J Orthop Sports Phys Ther 2010;40(5):256-264, Epub 12 March 2010. doi:10.2519/jospt.2010.3284.
Beattie
Paul F
PF
Department of Exercise Science, School of Public Health and the Department of Developmental Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC, USA.
Arnot
Cathy F
CF
Donley
Jonathan W
JW
Noda
Harmony
H
Bailey
Lane
L
D000328:Adult; D000704:Analysis of Variance; D004058:Diffusion; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000378:metabolism*; D017116:Low Back Pain / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000378:metabolism*; D008161:Lumbosacral Region / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D016684:Prone Position; D011446:Prospective Studies; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013997:Time Factors; D014867:Water / Q000378:metabolism*; D055815:Young Adult
D014867:Water