Treatment for the central sensitization component of lower back pain using systemic manual therapy

The purpose of this study was to analyze treatments for central sensitization (CS) and other contributors to chronic lower back pain (CLBP), using systemic manual therapy (SMT) protocols based on the temporal model for CS (TMCS).

Cohort retrospective multivariate analysis.

This study analyzed episode of care and rate of improvement data in 1053 patients, evaluating 715 protocol combinations of SMT.

While 682 (68%) patients reported improvement in overall symptoms, only 583 (53%) reported improvement in the lower back pain complaint. Comorbidities with statistically significant (p < 0.05) association with worse lower back pain outcomes were statin use, anxiety, depression, digestive and urinary issues, smoking and prior surgery. A significantly higher rate of improvement resulted from the use of 43 protocol combinations, which were composed of 19 protocols, a group that includes five protocols including urinary-drainage (UD), Diaphragm-cranial-sinus (DCS), Barral-abdominal-motility (Barral), lower-abdominal-urogenital (LAUG), and Cardiac-cervical-cranial-vascular (CCCV), which were all predicted to treat CS by the TMCS.

The results of this study support the use of SMT to treat CLBP and reinforce the TMCS hypothesis defining CS as a functional, multifaceted neurophysiological state rather than a purely structural adaptation of the CNS. The lower rate of improvement in CLBP compared to overall improvement and the correlations of worse outcome with certain comorbidities suggests that, in addition to SMT, a multimodal approach for CLBP should favor lifestyle improvements such as smoking cessation, lifelong exercise habits, and a balanced diet over medications and surgery.