Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Joshua Cleland

Date of original Performance / Presentation

January 2022

Publication Date / Copyright Date

1-1-2022

Abstract

Background: Low back pain (LBP) has reached epidemic proportions and effective management remains elusive. More recently, new strategies using manual interventions that address the role of neuromuscular control in the management of LBP have emerged. Participants: Individuals (n=66) who were currently receiving physical therapy, chiropractic, or no supervised care for chief complaint of nonspecific LBP attended one data collection session with 24-48 hour follow-up. Purpose: The purpose was to determine if a non-thrust physiologic with accessory lumbopelvic manipulation (LPM) applied over the sacrum and guided by a symptom-reproduction algorithm had an effect on: 1.) immediate changes in muscle thickness of the sacral multifidus (MF), measured by ultrasound imaging, 2.) immediate improvement in lumbar active range of motion (AROM), measured by inclinometry, and 3.) immediate/short-term improvement in self-reported pain, in individuals with nonspecific LBP. Methods: Participants were randomized into two groups. The dependent variables included self-reported pain and disability data as well as investigator-obtained data, including ultrasound images of sacral MF thickness at rest and during an isometric contraction, and sagittal plane lumbar AROM using double inclinometry. This data was obtained before, during, and following a single session of LPM or sham intervention. The LPM/sham was performed and all data was obtained in a single-blinded fashion by the primary investigator. Results: The non-thrust LPM and decision-making algorithm used in this study was effective in increasing the quantity of AROM for backward bending, t(30)=-4.432,p<.001, and improving immediate, t(30)=5.021,p<.001, and short-term, t(30)=2.447,p=.020, self-reported pain. Furthermore, forward bending LPM, t(12)=2.668,p=.020, and backward bending LPM, t(17)=4.278,p=.001, improved immediate post-manipulation pain and backward bending LPM, t(17)=3.322,p=.004, improved pain during the manipulation as well. Lastly, overpressure LPM improved pain during and immediately post-manipulation (t(20)=5.747,p=<.001, t(20)=4.628,p=<.001). Forces applied to the sacral base had the greatest effect on pain. Conclusion: LPM guided by a symptom-reproduction algorithm may be considered for improving deficits in lumbar backward bending and pain in individuals with LBP. The effects of LPM force location over the sacrum on pain suggests a need for improved stabilization in individuals with LBP and the possible contribution of the sacroiliac joint to LBP.

Disciplines

Physical Therapy

Keywords

Active Range of Motion; Low Back Pain; Lumbopelvic Manipulation; Neuromuscular; Rehabilitation Ultrasound Imaging; Sacral Multifidi

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