The relative effectiveness of manipulating the superior vertebral segment compared to manipulating the inferior vertebral segment in facet syndrome of the lumbar spine

Abstract

The purpose of this study was to evaluate the relative effectiveness of adjusting the superior vertebral segment as opposed to adjusting the inferior vertebral segment, of the two vertebral motion segments forming the facet joint responsible for the patient's symptoms and resulting in the diagnosis of facet syndrome, in the treatment of mechanical low back pain. Thirty subjects with mechanical low back pain were screened for facet syndrome and randomly divided into two groups of fifteen. Each patient received spinal manipulation for six treatments over 4 weeks, but the contact vertebra was different for each group. In the one group, contact was taken on the superior of the two vertebrae making up the facet syndrome, whereas contact was taken on the inferior of the two involved vertebrae in the second group. In the 'superior' group, the manipulative thrust was directed in the direction of the motion palpation findings, whereas in the 'inferior' group, the manipulative thrust was directed in the opposite direction to the motion palpation findings of the superior segment. Both groups were evaluated in terms of subjective and objective clinical findings by making use of questionnaires (Oswestry Back Pain and Disability Index; Numerical Pain Rating Scale-1 01; Short Form McGill) and goniometer measurements respectively.