Early Use of Thrust vs Non-Thrust Manipulation: RCT

Cook C et al. Early use of thrust manipulation vs. non-thrust manipulation: A randomized clinical trial. Manual Therapy: 2013

  • A study in 2009 by Cleland et al did examine differences b/w thrust and non-thrust manipulation and found that thrust manipulation was superior to non-thrust at 4 weeks and 6 months for disability-related outcomes.

  • The authors argue that what is not known is whether thrust manipulation is truly more effective than non-thrust manipulation when using techniques and methods commonly performed in clinical practice when administered early in the treatment process in pts with mechanical low back pain.

  • Pts involved in this RCT were recruited from 16 distinct outpatient clinics, needed to be > 18, and have mechanically reproducible LBP along with a within-session change following passive accessory examination.

  • The therapist was able to select either the thrust or non-thrust technique that they felt was would be most beneficial to their pt and target the area of the pts comparable sign.

  • Pt feedback was also used with all treatment techniques, allowing the therapist to modify the angle, position, force and rate, as well as target the spinal level producing the comparable sign, not a previously selected or randomized level.

  • Prior to the study, each therapist involved was evaluated to determine their personal equipoise regarding thrust and non-thrust techniques and if they had an opinion whether one treatment approach was superior to the other.

  • If personal equipoise is biased towards one arm of a trial over another, there is an increased potential for bias to be present. In this study, 3 clinicians had a bias towards thrust manipulation, 8 towards non-thrust, and 6 felt there was no difference.

  • In contrast to previous studies, the authors found no differences were observed b/w the early application of thrust vs. non-thrust manipulation for acute low back pain in terms of pain, disability, fear-avoidance, or perceived rate of recovery