Mobilization alone or with neuroplasticity education in CLBP
The understanding of the proposed mechanism of manual therapy has gone through a significant shift over the past 2 decades.
Research has shown that physical changes subsequent to manual therapy rarely occur as traditionally thought. Rather the effects are a result of transient neuro-physiological changes.
So, is it possible to expect different outcomes in people with CLBP if you explain the rationale for the manual therapy with the 'updated' model?
63 participants with CLBP were divided into 2 groups: the experimental group (EG) and the control group (CG).
Both groups received the same manual therapy (central PA mobilization) in a prone position for 10 minutes at grade 2 (Maitland). The EG received a 5-minute explanation of simplified neuroplasticity and shown a picture of the somatosensory cortex. The CG received a 5-minute explanation about the structure of low back shown a picture of the lumbar spine.
Post-treatment, the pain and lumbar flexion between the 2 groups were not significantly different, however, the straight leg raise outcome was significantly different.
The study concludes that manual therapy with neuroplasticity explanation results in improvement with SLR in patients with CLBP compared to those who received a traditional biomechanical explanation.
It may be worth commenting that most of the variables used in this study do not have established data. For example, grade 2 mobilization with a central PA direction on a lumbar spine does not have validated efficacy on LBP in relation to pain, ROM or SLR. Also, the SLR does not have an established association with the brain's cortical reorganization.
> From: Louw et al., J Man Manip Ther 24 (2018-01-29 08:09:45) 227-234. All rights reserved to Taylor & Francis Group. Click here for the online summary.