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Does Directional Preference Matter?

Does Directional Preference Matter?. Jason Soncrant, PT, DPT, SCS, CSCS Fellow in Training. Study Design : Subjects designated with a Directional Preference were assigned to 1 of 3 groups 1) Matched 2) Opposite 3) General Exercise

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Does Directional Preference Matter?

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  1. Does Directional Preference Matter? Jason Soncrant, PT, DPT, SCS, CSCS Fellow in Training

  2. Study Design: Subjects designated with a Directional Preference were assigned to 1 of 3 groups 1) Matched 2) Opposite 3) General Exercise • Directional Preference (DP):Operational Definition: When posture or repeated single plane end-range movement decreases midline lumbar or referred spine extremity pain Long A. Does it Matter Which Exercise? A Randomized Control Trial of Exercise for Low Back Pain. Spine.2004;29(23):2593-2602Level of Evidence: 1b, multicenter RCT

  3. Results: • 74% subjects (230) had DP • 1/3 subjects dropped out in unmatched groups < 2 weeks • Matched intervention had greater improvements in all outcomes (VAS, RMDQ, medication use) Bottom Line: • Standardized assessment with matched intervention could produce significant symptom reduction in 2 weeks Long A. Does it Matter Which Exercise? A randomized Control Trial of Exercise for Low Back Pain. Spine.2004;29(23):2593-2602Level of Evidence: 1b, multicenter RCT

  4. Study Design: Compare outcomes (ODI) between extension oriented exercises to general lumbar strengthening for LBP subjects with extension directional preference • Inclusion: 18-60 yo, > 30% disability on Oswestry Low Back Pain Questionnaire, (+) centralization • Exclusion: medical red flags, pregnancy, < 6 months s/p surgery • 63 of 300 met criteria Browder D. Effectiveness of an Extension-Oriented Treatment Approach in a Subgroup of Subjects with Low Back Pain: A Randomized Control Trial. PT Journal.2007;87(12);1-11Level of Evidence: 2b , no blinding and modest statistical results

  5. Results: Matched subjects (Extension DP + Extension exercises) showed decrease disability scores at weeks 1 & 4 and 6 months vs. strength group • Matched subjects only showed significant decrease in pain at 1 week • Bottom Line: modest difference with matched extension group but limited generalizability do to narrow inclusion criteria Browder D. Effectiveness of an Extension-Oriented Treatment Approach in a Subgroup of Subjects with Low Back Pain: A Randomized Control Trial. PT Journal.2007;87(12);1-11Level of Evidence: 2b , no blinding and modest statistical results

  6. Study Design: Compare outcomes between McKenzie Method and lower quarter manipulation for subjects w/ > 6 wks LBP • Blinded assessor at intake, subjects randomized into treatment groups and saw different clinician for treatment • McKenzie Treatment provided by certified MDT & manipulation provided on impairment basis along lower quarter by chiropractor Peterson T, The McKenzie Method Compared with Manipulation When Used Adjunctive to Information and Advice in Low Back Pain Patients Presenting with Centralization or Peripheralization. Spine.2011:36(24);199-2010Level of Evidence: 1b single blinded RCT

  7. Study Results: Both groups showed significant decrease in pain and disability (RMDQ) • At 2 months MDT(79%) > manipulation(59%) self reported success. This trend continued at 12 months • Bottom Line: Supports use of matched intervention for DL LBP but indirectly shows that manipulation should be considered as second tier treatment Peterson T, The McKenzie Method Compared with Manipulation When Used Adjunctive to Information and Advice in Low Back Pain Patients Presenting with Centralization or Peripheralization. Spine.2011:36(24);199-2010Level of Evidence: 1b single blinded RCT

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