Manual therapists emphasize the importance of the need for a detailed clinical examination to decide which vertebral level should be manipulated in patients with low back pain. However, it is not certain whether spinal manipulation needs to be specific to a vertebral level. The authors conducted this study to analyse the immediate effects of a single, region-specific spinal manipulation defined during the clinical examination versus a single non-region-specific spinal manipulation (applied on an upper thoracic vertebra) in patients with chronic nonspecific low back pain for the outcome measures of pain intensity and pressure pain threshold at the time of the assessment. 148 patients with chronic nonspecific low back pain (with pain duration of at least 12 weeks) underwent a single high-velocity manipulation to the upper thoracic region of the participants allocated to the non-region-specific manipulation group and to the painful lumbar levels of the participants allocated to the region-specific manipulation group. Pain intensity was measured by a 0 to 10 numeric pain rating scale. Pressure pain threshold was measured using a pressure algometer. Both groups improved in terms of immediate decrease of pain intensity; however, no between-group differences were observed. The between-group difference for pain intensity and pressure pain threshold were 0.50 points (95% confidence interval=-0.10 to 1.10) and -1.78 points (95% confidence interval=-6.40 to 2.82), respectively. No adverse reactions were observed.
In conclusion the researchers stated that the immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation did not vary by region-specific versus non-region-specific manipulation techniques in patients with chronic low back pain.