Blomberg,S, K Svardsudd, F Mildenberger, 1992, A controlled, multicentre trial of manual therapy in low-back pain. Initial status, sick-leave and pain score during follow-up: Scand.J.Prim.Health Care, v. 10, p. 170-178.Abstract: 101 outpatients with acute or subacute low-back pain were randomly allocated to one of two treatment groups. One group was given standardized conventional but optimal activating treatment by primary health care teams. The other group received manual treatment such as manipulation, specific mobilization, muscle stretching, auto-traction, and cortisone injections. The two groups were similar in most of the pretrial variables, including age, sex, previous low-back pain problems, sick-leave, previous treatment, findings at the physical examination, quality-of-life score, disability rating, and pain score. After one month in the study, the proportion of patients on sick-leave was six times larger in the conventionally treated group than in the group receiving the specific manual treatment. The difference diminished over time but was still significant after eight months. Two slightly different pain scores ("pain at the moment" and "pain during the last weeks"), initially similar in the two groups, diminished in both groups but were significantly lower in the manual treatment group during the study. The group receiving specific manual treatment thus had a significantly better outcome than the group receiving conventional treatment as far as sick-leave and pain score are concerned.
Blomberg,S, K Svardsudd, G Tibblin, 1993, Manual therapy with steroid injections in low-back pain. Improvement of quality of life in a controlled trial with four months' follow-up: Scand.J.Prim.Health Care, v. 11, p. 83-90.
Abstract: OBJECTIVE--To compare prospectively the effect of manual treatment such as manipulation, specific mobilization, muscle stretching, auto- traction, and cortisone injections with standardized conventional but optimized activating treatment by primary health care teams. DESIGN-- Prospective controlled multicentre trial with four months' follow-up. SETTING--Kopparberg County, Sweden. Six primary health care or occupational health care centres, representing a catchment area of 56000 residents participated. PARTICIPANTS--101 outpatients with acute or subacute low-back pain were, during the period February 1988 to April 1989, randomly allocated to one of two treatment groups. MAIN OUTCOME MEASURE--Quality of life was assessed at baseline and at four months by means of visual analogue scales (VAS). The occurrence of 27 different symptoms of a psychosomatic character was surveyed initially and at four months by questions answered by "yes" or "no" in a questionnaire. RESULTS--There were significant differences concerning quality of life and presence of general symptoms in favour of the group receiving manual treatment with steroid injections. CONCLUSION--Manual treatment with steroid injections was superior to conventional treatment in minimizing mental and somatic symptoms and increasing quality of life, in parallel with other measures of improvement.
Blomberg,S, K Svardsudd, G Tibblin, 1994, A randomized study of manual therapy with steroid injections in low- back pain. Telephone interview follow-up of pain, disability, recovery and drug consumption: Eur.Spine J., v. 3, p. 246-254.
Abstract: A total of 101 outpatients with acute or sub-acute low-back pain was randomly allocated to one of two treatment groups. One group was given standardised conventional and optimised activating treatment by primary health care teams. The other group received, according to a pragmatic approach, another treatment programme including manipulation, specific mobilisation, muscle stretching, autotraction and cortisone injections. The treatment effect was evaluated by standardised telephone interviews 3, 7, 14, 21 and 90 days after the start of treatment. The two groups were similar in most of the pretrial variables, including age, sex, occupation, education, previous low-back pain problems, previous treatment, sick-leave, findings at the physical examination, quality-of- life score, presence of common symptoms, disability rating and pain score. In the early phase as well as at the 90 days' follow-up, the group receiving manual therapy had significantly less pain, less disability, faster rate of recovery and lower drug consumption, indicating that this type of treatment is superior to conventional treatment.
Blomberg,S, G Hallin, K Grann, E Berg, U Sennerby, 1994, Manual therapy with steroid injections--a new approach to treatment of low back pain. A controlled multicenter trial with an evaluation by orthopedic surgeons: Spine, v. 19, p. 569-577.
Abstract: Fifty-three acute or subacute patients with low back pain were given standardized but optimized activating conventional treatment by primary health care teams. Forty-eight patients received an experimental treatment that included specific manual treatment, such as manipulation and specific mobilization, muscle stretching, auto-traction, and cortisone injections. After 4 months, the experimental group had a less restricted range of movement in extension, less restricted side-bending to the right and to the left, less local pain caused by extension and side-bending to the right, less pain radiating to the right leg caused by side-bending to the left, and a less positive straight leg raising test (both sides) than the conventionally treated group. Manual treatment was superior to the conventional activating treatment in normalizing pathologic findings on physical examination of the lower back. These results agree with the positive influence on pain, drug consumption, sick-leave, disability rating, and quality of life reported in other reports from the same study.
Blomberg,S, G Hallin, K Grann, E Berg, U Sennerby, 1994, Manual therapy with steroid injections--a new approach to treatment of low back pain. A controlled multicenter trial with an evaluation by orthopedic surgeons [see comments]: Spine., v. 19(5), p. 569-577.
Notes: Fifty-three acute or subacute patients with low back pain were given standardized but optimized activating conventional treatment by primary health care teams. Forty-eight patients received an experimental treatment that included specific manual treatment, such as manipulation and specific mobilization, muscle stretching, auto-traction, and cortisone injections. After 4 months, the experimental group had a less restricted range of movement in extension, less restricted side-bending to the right and to the left, less local pain caused by extension and side- bending to the right, less pain radiating to the right leg caused by side-bending to the left, and a less positive straight leg raising test (both sides) than the conventionally treated group. Manual treatment was superior to the conventional activating treatment in normalizing pathologic findings on physical examination of the lower back. These results agree with the positive influence on pain, drug consumption, sick-leave, disability rating, and quality of life reported in other reports from the same study Department of Family Medicine, Uppsala University, Sweden.
Tullberg,T, S Blomberg, B Branth, R Johnsson, 1998, Manipulation does not alter the position of the sacroiliac joint. A roentgen stereophotogrammetric analysis: Spine., v. 23(10), p. 1124-8; discussion 1129.
Notes: STUDY DESIGN: A roentgen stereophotogrammetric analysis study of patients with sacroiliac joint dysfunction. OBJECTIVES: To investigate whether manipulation can influence the position between the ilium and the sacrum, and whether positional tests for the sacroiliac joint are valid. SUMMARY OF BACKGROUND DATA: Sacroiliac joint dysfunction is a subject of controversy. The validity of different sacroiliac joint tests is unknown. Long- standing therapeutic tradition is to manipulate supposed dysfunctions of the sacroiliac joint. Many manual therapists claim that their good clinical results are a consequence of a reduction of subluxation. METHODS: Ten patients with symptoms and sacroiliac joint tests results indicating unilateral sacroiliac joint dysfunction were recruited. Twelve sacroiliac joint tests were chosen. The results of most of these tests were required to be positive before manipulation and normalized after manipulation. Roentgen stereophotogrammetric analysis was performed with the patient in the standing position, before and after treatment. RESULTS: In none of the 10 patients did manipulation alter the position of the sacrum in relation to the ilium, defined by roentgen stereophotogrammetric analysis. Positional test results changed from positive before manipulation to normal after. CONCLUSIONS: Manipulation of the sacroiliac joint normalized different types of clinical test results but was not accompanied by altered position of the sacroiliac joint, according to roentgen stereophotogrammetric analysis. Therefore, the positional test results were not valid. However, the current results neither disprove nor prove possible beneficial clinical effects achieved by manipulation of the sacroiliac joint. Because the supposed positive effects are not a result of a reduction of subluxation, further studies of the effects of manipulation should focus on the soft tissue response.
Tullberg,T, S Blomberg, B Branth, R Johnsson, 1998, Manipulation does not alter the position of the sacroiliac joint. A roentgen stereophotogrammetric analysis: Spine, v. 23, p. 1124-1128.
Abstract: STUDY DESIGN: A roentgen stereophotogrammetric analysis study of patients with sacroiliac joint dysfunction. OBJECTIVES: To investigate whether manipulation can influence the position between the ilium and the sacrum, and whether positional tests for the sacroiliac joint are valid. SUMMARY OF BACKGROUND DATA: Sacroiliac joint dysfunction is a subject of controversy. The validity of different sacroiliac joint tests is unknown. Long-standing therapeutic tradition is to manipulate supposed dysfunctions of the sacroiliac joint. Many manual therapists claim that their good clinical results are a consequence of a reduction of subluxation. METHODS: Ten patients with symptoms and sacroiliac joint tests results indicating unilateral sacroiliac joint dysfunction were recruited. Twelve sacroiliac joint tests were chosen. The results of most of these tests were required to be positive before manipulation and normalized after manipulation. Roentgen stereophotogrammetric analysis was performed with the patient in the standing position, before and after treatment. RESULTS: In none of the 10 patients did manipulation alter the position of the sacrum in relation to the ilium, defined by roentgen stereophotogrammetric analysis. Positional test results changed from positive before manipulation to normal after. CONCLUSIONS: Manipulation of the sacroiliac joint normalized different types of clinical test results but was not accompanied by altered position of the sacroiliac joint, according to roentgen stereophotogrammetric analysis. Therefore, the positional test results were not valid. However, the current results neither disprove nor prove possible beneficial clinical effects achieved by manipulation of the sacroiliac joint. Because the supposed positive effects are not a result of a reduction of subluxation, further studies of the effects of manipulation should focus on the soft tissue response.
