Low back pain (LBP) is cited as the second most common musculoskeletal problems for which treatment is sought by individuals. An estimated 90% of LBP reported in clinical practice is categorized as idiopathic or nonspecific, meaning that the underlying pathoanatomy is unclear (Walker, 2000). Spinal manipulation (SM) has been identified as efficacious treatment methods, especially for patients with nonspecific LBP (Slater, 2012). Early use of thrust manipulation among patients with LBP has been claimed for better outcomes and provides rapid recovery (Laerum et al., 2007). High velocity, low amplitude (HVLA) thrust techniques of the spine are also known by several names, e.g. High Velocity Thrust Manipulation, Spinal Adjustment, and Grade V mobilization
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Spinal manipulation clinical prediction rule (CPR) is one of such CPRs; that facilitating prognosis or predicting the effect of patients likely to benefit from SM. It was derived by Flynn et al in 2002 and validated by Childs et al in 2004 and is a stage II CPR. This implies it can be confidently used in different clinical settings, on a wide range of patients by clinicians with different experiences, provided of course that it is used accurately. The predictors are as follows: 1) duration of symptoms less than 16 days; 2) no symptoms distal to the knee; 3) Fear Avoidance Beliefs Questionnaire Work subscale score more 19; 4) hip internal rotation greater than 35 degrees and 5)more than one lumbar segments stiffness with manual assessment. Patients are most likely to advantage from SM if they satisfy 4 out of 5 of these predictors.
The purpose of this case study is to describe the immediate effect of spinal manipulation in reducing pain and improving lumbar movement on a patient who met four out of the five criteria on the CPR. This case study emphasized on patients diagnosed as non-specific LBP fitting into the subgroup identified as likely to respond positively to thrust manipulation. Techniques used in the study included the side lying HVLA rotational manipulation (Cleland, 2009) of the lumbar
Spinal manipulation clinical prediction rule (CPR) is one of such CPRs; that facilitating prognosis or predicting the effect of patients likely to benefit from SM. It was derived by Flynn et al in 2002 and validated by Childs et al in 2004 and is a stage II CPR. This implies it can be confidently used in different clinical settings, on a wide range of patients by clinicians with different experiences, provided of course that it is used accurately. The predictors are as follows: 1) duration of symptoms less than 16 days; 2) no symptoms distal to the knee; 3) Fear Avoidance Beliefs Questionnaire Work subscale score more 19; 4) hip internal rotation greater than 35 degrees and 5)more than one lumbar segments stiffness with manual assessment. Patients are most likely to advantage from SM if they satisfy 4 out of 5 of these predictors.
The purpose of this case study is to describe the immediate effect of spinal manipulation in reducing pain and improving lumbar movement on a patient who met four out of the five criteria on the CPR. This case study emphasized on patients diagnosed as non-specific LBP fitting into the subgroup identified as likely to respond positively to thrust manipulation. Techniques used in the study included the side lying HVLA rotational manipulation (Cleland, 2009) of the lumbar