|
JLS_PT_OCS -> Re: Diagnosis and Palpation in Manual Tx (March 3, 2005 7:27:00 AM)
|
In this vein, here is an abstract from CSM showing no real change after lumbosacral manipulation. One of the study authors is a coworker, who tells me that assymetry findings seemed to be a mixed bag between those who improved and those who did not.
In this case, weight bearing assymmetry refers to weight shifting toward one LE over another in standing. It is well-studied in Cibulka's work on assymmetry, and that's why it was used in the study. Frontal plane pelvic assymetry refers to iliac crest height.
Here it is:
Changes in Pelvic Asymmetry, Functional Status, and Pain in Subjects with Low Back Pain More Likely to Respond to Manipulation.
SESSION TYPE: Oral;
SESSION TOPIC: Orthopaedics;
Abstract Details
AUTHORS (ALL): Loomis, Gregory2; Sutlive, Thomas G.1; Weigel, Kara3; Mendoza, Aldo4; Morris, Krystal6; Rendeiro, Daniel5; Wainner, Robert S.1.
INSTITUTIONS (ALL): 1. Physical Therapy, US Army-Baylor University, San Antonio, TX, USA.
2. Physical Therapy, Walter Reed Army Medical Center, Washington DC, DC, USA.
3. Physical Therapy, DeWitt Army Community Hospital, Fort Belvoir, VA, USA.
4. Physical Therapy, Eisenhower Army Medical Center, Fort Gordon, GA, USA.
5. Physical Therapy, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
6. Physical Therapy, Martin Army Community Hospital, Fort Benning, GA, USA.
ABSTRACT BODY:
Purpose/Hypothesis : The purposes of this study were to determine 1) if changes in pelvic crest alignment and side to side weight-bearing differences occur following intervention with spinal manipulation therapy (SMT), and if so, if the changes are associated with a response to intervention; and 2) if pelvic crest alignment and side to side weight-bearing differences prior to manipulation are associated with a successful response to manipulation, both immediately and at 48 hours.
Number of Subjects : 49 volunteers (28 men, 21 women) with acute LBP served as subjects.
Materials/Methods : Pelvic crest alignment and side-to-side weight bearing asymmetry were measured before and after intervention with SMT. Pain and disability self-reports were obtained pre- and post-manipulation, and at 48 hours. Immediate treatment success was defined as a 30% reduction in pain, and success at 48 hours was defined as a 30% reduction in pain or disability, or 3-point improvement on a global rating of change (GRC) questionnaire. Data were analyzed to determine 1) if there was a significant change in alignment/asymmetry measures following SMT, and 2) which variables were associated with success.
Results : Only seated frontal plane pelvic asymmetry (PA) changed significantly after SMT. The following variables were associated with a successful response to manipulation immediately and at 48 hours: PA > 6mm in standing (immediate odds ratio (OR) =11.1, 48-hour OR = 5.2); PA > 6mm in sitting (immediate OR=6.7, 48-hour OR = 2.4); and weight bearing asymmetry (WBA) > 11% (48-hour OR = 3.7).
Conclusions : Frontal plane PA and WBA were associated with a successful response to SMT. Further study of the association between impairments and response to SMT may help elucidate mechanisms underlying therapeutic response to SMT.
Clinical Relevance : The findings of this study may clinicians identify a priori patients who are likely to respond to SMT.
Looking at predictive variables, you had to have a significant pelvic (6mm) or weight bearing assymetry to benefit. Perhaps like a lateral shift?
Anyway, some more evidence that treating the assymetry may not be the way to go...
J
|
|
|
|