Manual versus mechanical force manipulation in the treatment of lumbar facet syndrome

M.Tech.Purpose: This study aims to compare the effects of a manual high velocity, low amplitude spinal manipulation and a mechanical force, manually assisted spinal manipulation in the treatment of sub acute lumbar facet syndrome with regards to pain, disability, lumbar spine range of motion and pressure pain threshold. These effects were based on two questionnaires, the McGill Pain Questionnaire and the Oswestry Low Back Pain and Disability Questionnaire, lumbar spine range of motion readings using a digital inclinometer and pressure pain threshold readings taken with an algometer. Method: Thirty participants who met the inclusion criteria were randomly allocated to one of two groups. One group received a manual lumbar spine manipulation using the Diversified Technique. The second group received lumbar spine manipulative therapy with the use of the Activator Adjusting Instrument. Treatment occurred over a three week period, with participants receiving treatment six times out of a total of seven consultations. Procedure: Subjective data was collected using both the McGill Pain Questionnaire and the Oswestry Low Back Pain and Disability Questionnaire. Objective data was collected using a digital inclinometer to measure lumbar spine range of motion, and an algometer to measure pressure pain threshold. The questionnaires and all readings were recorded prior to treatment on the first, fourth and seventh visits. The data was then analysed by a statistician. Results: Clinical improvements in both groups were noted over the duration of the study with regards to pain, disability, left rotation and left and right lateral flexion. The group receiving a spinal manipulation with the Activator Adjusting Instrument also showed clinical improvement for flexion and right rotation and only the manual manipulation group improved in algometer measurements. Both groups displayed a decrease in lumbar extension readings over time. Statistical significance was observed for subjective measurements only. Conclusion: The results show that both spinal manipulative therapies are effective in the treatment of sub acute lumbar facet syndrome, however neither proved to be preferential over the other for subjective and objective measurements