title: Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial.
abstract: BACKGROUND
  Manual therapists typically advocate the need for a detailed clinical examination to decide which vertebral level should be manipulated in patients with low back pain. However, it is unclear whether spinal manipulation needs to be specific to a vertebral level.
  
  
  OBJECTIVE
  The purpose of this study was to analyze the immediate effects of a single, region-specific spinal manipulation defined during the clinical examination versus a single non-region-specific spinal manipulation (applied on an upper thoracic vertebra) in patients with chronic nonspecific low back pain for the outcome measures of pain intensity and pressure pain threshold at the time of the assessment.
  
  
  METHODS
  This was a 2-arm, prospectively registered, randomized controlled trial with a blinded assessor.
  
  
  METHODS
  The study was conducted in an outpatient physical therapy clinic in Brazil.
  
  
  METHODS
  The study participants were 148 patients with chronic nonspecific low back pain (with pain duration of at least 12 weeks).
  
  
  METHODS
  The randomization schedule was generated by an independent statistician and was concealed by using consecutively numbered, sealed, opaque envelopes.
  
  
  METHODS
  A single high-velocity manipulation was administered to the upper thoracic region of the participants allocated to the non-region-specific manipulation group and to the painful lumbar levels of the participants allocated to the region-specific manipulation group.
  
  
  METHODS
  Pain intensity was measured by a 0 to 10 numeric pain rating scale. Pressure pain threshold was measured using a pressure algometer.
  
  
  CONCLUSIONS
  It was not possible to blind the therapist and participants.
  
  
  RESULTS
  A total of 148 patients participated in the study (74 in each group). There was no loss to follow-up. Both groups improved in terms of immediate decrease of pain intensity; however, no between-group differences were observed. The between-group difference for pain intensity and pressure pain threshold were 0.50 points (95% confidence interval=-0.10 to 1.10) and -1.78 points (95% confidence interval=-6.40 to 2.82), respectively. No adverse reactions were observed.
  
  
  CONCLUSIONS
  The immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region-specific versus non-region-specific manipulation techniques in patients with chronic low back pain.
authors: Universidade Cidade de São Paulo, São Paulo, Brazil.
authors: Ronaldo Fernando
authors: RF
authors: de Oliveira
authors: Richard Eloin
authors: RE
authors: Liebano
authors: Lucíola da Cunha Menezes
authors: Lda C
authors: Costa
authors: Lívia Leticia
authors: LL
authors: Rissato
authors: Leonardo Oliveira Pena
authors: LO
authors: Costa
mesh_terms: D059350:Chronic Pain / Q000628:therapy*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold; D011446:Prospective Studies; D016037:Single-Blind Method