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There are many treatments that can be used to help treat low back pain. Two treatments that physical therapists use are spinal posterior to anterior (P-A) mobilizations and prone press-ups. I was curious about the effectiveness of both of these treatments and which one has the better outcome. I came across this article that helped to answer this question.

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Effects of a single session of PA spinal mobilization and press-up exercise on pain response and lumbar spine extension

The researchers compared a single session of P-A segmental mobilization to press-ups and measured pain with a visual analog scale and lumbar extension range of motion with an MRI on individuals with nonspecific low back pain.  They found significant improvement in pain and lumbar extension range of motion but no difference between the two treatment options.  Even though there was no significant difference between the two treatment options the participants treated with P-A mobilizations had an average reduction of pain by 41% and an average increase in lumbar extension motion of 17.8% and the press-up group reduced pain by 30% and increased motion by 11.7%.

Purpose: To examine the immediate effects of P-A mobilization and a press-up exercise on pain with standing extension and lumbar extension in people with nonspecific low back pain.

Methods: The participants consisted of 30 individuals between the ages of 18 and 45 years old.  Inclusion criteria consisted of a recent onset of back pain (<3 months), localized low back pain at or above the waist level, decreased lumbar extension during standing, and increased low back pain with standing lumbar extension.  Participants were excluded if they had spinal malignancy, cardiovascular disease, evidence of cord compression, aortic aneurysm, hiatal hernia, uncontrolled hypertension, spinal infection, severe respiratory disease, pregnancy, abdominal hernia, prior low back surgery, gross spinal deformity, spondylolisthesis, rheumatic joint disease, and implanted devices that may be affected by MRI.  Other exclusion criteria consisted of radiating pain below the buttocks, sensation changes in the lower extremities, diminished reflexes, low extremity weakness, neurological signs, urinary or fecal incontinence, or increased pain with repetitive lumbar extension.

  • P-A Spinal Mobilization – The mobility of the lumbar spinal segments were assessed and the segments with hypomobility and a reproduction of symptoms were the target areas.  The subject was placed in prone with a pillow under the stomach.  Each segment was assessed with 1-2 Grade I mobilizations.  If there were no reproduction in symptoms then mobilizations increased to Grade III and IV.  If there was no reproduction in symptoms then the next segment was assessed until a painful segment was found.  Once a painful segment was found the examiner completed 3 sets of 40 second oscillations to a Grade IV intensity or just shy of pain reproduction.
  • Press-ups – A press-up was completed as far as possible without a reproduction of symptoms.  The subject was prone on a table and extends the arms to lift the chest.  The hips and pelvis may lift from the table and sag due to gravity.  The subject was instructed to hold for 5 seconds and repeat 10 times.  The subject was encouraged to go higher each time.  If the symptoms reduced or were unchanged then 2 more sets were completed.

Limitations: The study had 5 reported limitations.  They stated that the participants were relatively young which allowed for greater absolute lumbar extension range of motion which would not be possible with more elderly individuals.  The inclusion criteria was quite selective making the results difficult to generalize to other people with low back pain.  The examiners only assessed the immediate effects of the treatments and not the long term effects.  The study did not have a sham group to assess the placebo effect of treatment.  Finally, they mentioned that they were not able to exactly reproduce the pretreatment resting position during the post-treatment MRI assessment.

 

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