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How should we teach lumbar manipulation? A consensus study.

Michael O'Donnell1, Jo Armour Smith2, Alex Abzug3

  • 1Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP-155, Los Angeles, CA 90089, USA.

Manual Therapy
|July 17, 2016
PubMed
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This study identified key elements for effective side-lying lumbar spine manipulation. Consensus was reached on patient positioning, operator technique, and thrust characteristics for optimal outcomes in treating low back pain.

Area of Science:

  • Manual Therapy
  • Spinal Manipulation
  • Musculoskeletal Rehabilitation

Background:

  • Spinal manipulation is a recognized treatment for low back pain.
  • Inconsistent teaching methods exist for spinal manipulation skills.
  • Standardizing the teaching of side-lying lumbar manipulation is needed.

Purpose of the Study:

  • To determine expert consensus on crucial patient and operator positioning for side-lying lumbar manipulation.
  • To identify essential patient positions and operator movements during the manipulative thrust.
  • To establish best practices for teaching side-lying lumbar manipulation.

Main Methods:

  • A multi-disciplinary Delphi method was employed.
  • Three rounds of questionnaires were administered to physical therapists, osteopaths, and chiropractors.
Keywords:
DelphiEducationLumbar spineManual therapySpinal manipulative therapy

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  • Consensus was defined as at least 75% agreement on a 5-point Likert scale.

    • Main Results:

    • Consensus was achieved on preparatory phase elements: target segment localization, patient comfort, table height, and logrolling.
    • During the manipulation phase, agreement focused on maintaining segment localization and rotating the pelvis/lumbar spine.
    • Operator technique consensus included moving over the patient, forearm contact, close patient contact, force generation through the body, downward body drop, and HVLA thrust.

    Conclusions:

    • The Delphi study successfully defined key patient and operator characteristics for effective side-lying lumbar spine manipulation.
    • This consensus provides a foundation for standardized teaching and practice of this technique.
    • The findings contribute to improving the consistency and efficacy of manual therapy for low back pain.