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Comparing Spinal Mobilization to Spinal Extension Exercises for Low Back Pain

Physical therapists (PTs) are involved in an ongoing effort to find out what works best to treat nonspecific low back pain (LBP). Nonspecific refers to the fact that no known cause can be found for the pain.

In this study, the results of two specific types of treatment for nonspecific LBP are compared. The first group received spinal mobilization. Mobilization is a technique used by PTs to improve movement at each individual vertebral level. The therapist applies pressure to the vertebra in a rhythmical and repetitive way. The authors describe the specific way in which spinal mobilization was applied to each patient.

The second group performed press-up exercises. These are done by the patient while lying face down on a table or mat. Using the arms, the upper body is pushed up away from the surface. The muscles of the back are kept relaxed, so that the arms do all the work. The abdomen and pelvis are allowed to sag back down onto the supporting surface. The authors also offered more details about the press-up technique used for this study.

Pain level was measured and dynamic MRI imaging of the lumbar spine was performed. Vertebral angles measured on the MRI gave a measurement of spinal motion at that level.
Both measures were taken before and right after a single-session using either mobilization or press-ups. The person collecting this information did not know which treatment group each patient had been in.

Pain was less for patients in both groups after one treatment. Lumbar extension (backward motion of the low spine) was improved in both groups. There was a slightly greater amount of motion improvement in the mobilization group. However, one treatment was not more effective than the other in achieving overall pain relief or increasing motion.

The authors point out some limitations of their study that should be considered. First, the small change in lumbar motion may have been linked to the patient's age or activity level. All the patients in this study were young and active.

Second, the results of this study are short-term (after one session). Long-term results still need to be investigated. Some changes in pain and motion could have occurred from the testing procedures themselves. More studies are needed to evaluate these two treatment techniques for nonspecific LBP.


Christopher M. Powers, PT, PhD, et al. Effects of a Single Session of Posterior-to-Anterior Spinal Mobilization and Press-Up Exercise on Pain Response and Lumbar Spine Extension in People with Nonspecific Low Back Pain. In Physical Therapy. April 2008. Vol. 88. No. 4. Pp. 485-493.

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