Spinal Manipulation - Low Back Pain Management

Question 1

Are the following contraindications or precautions to maniuplation?

• If changes in sensation or pain radiate down to an extremity
• pt is pregnant
• current history or corticosteroid use or has excessive pain

Answer 1

Precautions

Question 2

Are the following contraindications or precautions to maniuplation?

• unhealed fracture
• history of joint or ligamentous laxity
• spondylolisthesis
• acute joint inflammation/irritation
• cauda equina syndrome
• HVT in persons with history of osteoporosis or osteopenia

Answer 2

Contraindications

Question 3

Pt will most likely benefit from spinal manip. if they met 4 of these 5 criteria:

Answer 3

• symptom duration less than 16 days
• no symptoms distal to knee
• scores less than 19 on FABQ work subscale
• at least 1 hypomobile lumbar segment
• 1 hip with more than 35 degrees of IR

Question 4

Are the following factors for or against manipulation?

• more recent onset of symptoms
• hypomobility with spring testing
• low back pain only
• low FABQ scores (FABQW < 19)

Answer 4

Factors favoring manipulation

Question 5

Are the following factors for or against manipulation?

• symptoms below the knee
• increasing episode frequency
• peripheralization with motion testing
• no pain with spring (PA mobility) testing

Answer 5

Factors against manipulation