A common strategy employed by Physical Therapists to treat low back pain involves the combination of lumbar joint mobilizations and McKenzie or prone press-ups. To date there has been some conflicting evidence about the effectiveness of these two interventions.
In related posts I have reviewed some of the evidence that supports use of the McKenzie Method for treating back pain (http://digg.com/d31Q8IA).
A recent study provides some interesting insight into (1) what types of patients may benefit from this combination of treatments and (2) why it actually is helpful.
In 2008 Beattie et al. demonstrated that posterior-to-anterior (PA) pressures “generate a stimulus that results in a rapid, measureable increase in diffusion of water within the nuclear region of the intervertebral disc [IVD].”[i]
The authors expand their previous work look at why some patients had different responses to the same treatment.[ii] The study looked at patients with low back pain that fit the following criteria (extension-based treatment) with low back pain symptoms provoked/increased/peripheralized by:
- Lumbar forward bending
- Prolonged sitting to a greater degree than with lumbar backward bending, or walking.
In the study, patients that met the inclusion criteria were given the following treatments:
- PA mobilizations with the delivery of “graded oscillating PA pressures to the spinous processes of each lumbar vertebra, starting with L5 and progressing rostrally to L1. Two sets of oscillating pressures of 30 seconds each were performed at each level.
- Immediately after the manual therapy intervention, the patient was instructed to perform 3 sets of 10 prone press-ups, using the procedure described by McKenzie (http://digg.com/d31Q8IA).
The authors found that people that responded quickly to this intervention had evidence on MRI scanning of an “increase in diffusion of water in the nuclear region of the intervertebral disc.” [iii] These findings may explain one mechanism by which manual therapy (or having joints mobilized) could have an immediate effect on pain. What is more, improving disc hydration could potentially carry with it benefits in terms of disc nutrition, health and recovery.
So, if you have back pain that is worse with sitting or lumbar flexion and have not tried this type of treatment, it is worth thinking about. If nothing else maybe it will make you taller (because of the increase in disc hydration).
[i] Orthop Sports Phys Ther. 2008;38:42-49.