Low Back Pain changes following Lumbar Mobilization and Prone Press Ups - Effects on Discs

Beatie PF et al. Immediate reduction in LBP intensity following lumbar joint mobilization and prone press-ups is associated with increased diffusion of water in the L5/S1 intervertebral disc. JOSPT May 2010
  • The purpose of this study was to determine the differences in diffusion of water in the IV disc at L5-S1 between subjects who had an immediate reduction in pain of 2/10 on NPRS following p-a mobilizations and prone press-ups compared to those who did not report an immediate change in symptoms. 

  • Subjects were included if they were b/w 20-60 yrs of age and reported LBP of at least 2/10 and had clinical signs and symptoms that they responded to an extension-oriented treatment approach. This was determined by symptoms that were provoked or worsened (moving from midline-laterally or to LE) with lumbar forward bending or prolonged sitting to a greater degree than with backward bending or walking. It was also assumed that if subjects were considered to be hypomobile with p-a testing, that they may benefit from p-a mobilization intervention

  • The main author of the study performed the initial examination of all subjects and determined who met inclusion criteria for the study based on the findings. Following the examination, MRI was performed on all subjects included in the study.

  • After the initial MRI was completed, a second examiner, who was blinded to all subject information, began the intervention performing p-a mobilizations starting at L5 up to L1. Mobilizations were performed at the highest grade (Maitland I-IV) as tolerated by pt. 2 sets of 30 second oscillations were performed at each level.

  • Immediately following the mobilizations, the subject was instructed to perform 3 sets of 10 press-ups as described by McKenzie. Upon completion of the exercise, the subject returned to the MRI machine in same initial supine position for a repeat scan and was also assessed for pain level following treatment.

  • Subjects who had reductions in pain intensity of 2/10 or greater immediately following intervention were classified as "immediate responders" and all others were classified as non-immediate responders

  • A total of 20 subjects were included in the study, 12 female and 8 male. 10 subjects, 5 male/5 female had pain intensity reduction of 2/10 or greater on NPRS and were classified as immediate responders. 

  • A significant interaction b/w group and time was present, suggesting that the immediate responder group had a greater change in diffusion of water than the non-immediate responders. There was a 4.2% increase in diffusion for the immediate responders compared to a 1.6% in the non-immediate responders. 

  • These findings, although preliminary, suggest a potential linkage b/w the changes in diffusion of water into the IV disc and pt reports of changes in pain immediately following an extension-oriented treatment approach combining manual therapy and exercise.

  • The authors’ acknowledge that due to the preliminary nature of the findings, it is hard to determine the clinical relevance at this time and obviously, more research into this is needed