# Comfort during side posture lumbopelvic manipulation in a low back pain population—effects of a typical versus modified flexed lumbopelvic position: a crossover randomized control trial

## TL;DR

This study compared two spinal manipulation positions for low back pain and found no overall comfort difference, though some individuals preferred one over the other.

## Contribution

The study introduces a modified flexed position for spinal manipulation and explores individual comfort preferences in low back pain patients.

## Key findings

- No significant difference in comfort was found between standard and modified spinal manipulation positions.
- 14 participants showed a clinically significant comfort preference for one position over the other.
- No correlation was found between active range of motion comfort and spinal manipulation comfort.

## Abstract

Literature on low back pain (LBP) treatment suggests not all LBP is the same and patients with extension- or flexion-related LBP may benefit from different strategies. This study’s objective was to evaluate the effect of participant positioning when delivering spinal manipulation on reported immediate comfort, in individuals with LBP.

This a randomized crossover trial. Volunteer adult participants with LBP were recruited from a chiropractic college campus clinic to receive two procedures in random order: 1. Standard side posture lumbopelvic manipulation (SPLM) and 2. Modified flexed lumbopelvic manipulation. The modified position was similar to the standard, but with increased hip and lumbopelvic flexion. Participants were not blinded. The primary outcome of self-reported comfort was recorded using a 0–10 scale. Paired t-tests were used to compare mean comfort scores, and a minimal clinically important difference of 2.0 was used. Secondary analysis examined correlations between comfort during active range of motion (AROM) and the two SPLM procedures. An exploratory analysis comparing within-participant differences was examined. All reported harms were mild in nature (e.g. discomfort).

Forty participants were recruited (mean 25.5 years of age, 75% female). 20 participants started with the Standard SPLM and 20 started with the Modified Flexed SPLM. No differences in comfort were found between the Standard SPLM (N = 40) versus Modified flexed SPLM (N = 40), (mean (SD) = − 0.01 (2.3), Effect Size Cohen’s d = − 0.004 95% CI (− 0.32, 0.32)). No correlations were found between the comfort during AROM and the two SPLM procedures. Observing within-participant differences for individual comfort, 14 participants had a clinically significant difference ≥ 2. Specifically, 6 participants had lower scores with Standard SPLM and 8 participants had lower scores with Modified flexed SPLM.

Comparing comfort during a Modified flexed SPLM to the Standard one revealed no difference for a population with LBP. However, some individuals did demonstrate a comfort preference for a Standard versus a Modified flexed position. Future studies should examine other variations of manipulation and particular subgroups of individuals with LBP (e.g. direction related) that experience discomfort during manipulation.