An article published in the scientific journal, Spine in 2004, by Physical Therapist Audrey Long and Orthopedic Physician Ron Donelson clarifies the debate on whether the type of spinal movements matters to speed of recovery. In their study, these researchers determined whether previously validated low back pain subgroups responded differently to contrasting exercise prescriptions.
The multi-centred randomized controlled trial included 312 low back pain clients who were divided into subgroups depending on their responses to mechanical assessment of the spine. Each subgroup was characterized by immediate and clear response to movements of flexion, extension, side-bending or rotation. Each subgroup was then given a “directional preference” for one of these movements. In other words, there was pain relief while moving in that particular direction. These clients were randomly assigned to one of three groups. One group was given exercises that matched the directional preference; another group was given exercises that moved in an opposite direction to directional preference, while the final group was given exercises with no specific directional preference. One third of the subgroups who were performing exercises opposite to the directional preference and no particular directional preference withdrew from the study due to increase in pain. The subgroup performing exercises that matched directional preference completed the study with significant reduction in pain, medication use, work interference and disability (P<.0001). Consistent with prior evidence (notably Hamilton Hall – Back Doctor) standardized mechanical assessment can identify subgroups of clients. Matching exercise movements to directional preference, as determined by assessment, can result in significant improvement in disability scores, pain reduction and work outcomes. A physiotherapist with experience in this approach, notably the McKenzie approach, is trained to implement such a treatment regimen. Should you have any questions or concerns regarding this clinical brief, please contact Hercules Grant PhD.