Affiliations: [a] University of Louvain, IREC-CARS, Parnasse-ISEI, Brussels, Belgium | [b] Orthopaedic Manual Therapy, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium
Correspondence:
[*]
Address for correspondence: Benjamin Hidalgo, Faculté des Sciences de la Motricité, Université Catholique de Louvain, Place Pierre de Coubertin 1, bte L8.10.01 à 1328 Louvain-La-Neuve, Belgium. Tel.: +32 10 47 44 18; Fax: +32 10 47 31 06; E-mail:benjamin.hidalgo@uclouvain.be
Abstract: BACKGROUND AND OBJECTIVES: Orthopaedic manual therapy (OMT) should be based not only on the best
available evidence but also on patient values and clinician expertise. Low
back pain (LBP) is a complex issue as the majority of people who suffer from
LBP cannot be given a specific diagnosis based on imaging studies but
kinematic analyses appear to be useful to determine dysfunctional patterns.
In physical therapy, various forms of OMT are currently used to manage LBP
and there is growing evidence for its use. The underlying principles of OMT
are to treat neuro-musculo-skeletal disorders, the aim of which is to reduce
pain, as well as improve movement and function. Manual physical therapists
use a range of treatment approaches including passive techniques (``hands
on'') as well as different active techniques (``hands off'') and
communication skills. Systems of stratification are available for
classification of people with LBP into specific sub-groups (with sub-group
specific OMT intervention). This approach has been shown to be more
efficient than generic treatment, although subgroups are not mutually
exclusive. Various mechanisms of action are reported in the literature
concerning OMT effects. These effects may be biomechanical,
neurophysiological and psychological. Moreover, it is essential that the
treatment, regardless of the concept of OMT, is carried out on the basis of
a systematic and valid clinical examination protocol aimed to correctly
classify LBP. The use of pain provocative tests during combined movement
examination provides confidence that examination findings are valid and can
therefore be confidently used in clinical practice to manage patient. The
integrative approach presented in this article is a mix of previously
developed classification systems (i.e. based on pain mechanisms, prognosis,
treatment responsiveness) and new tools, as kinematic analyses for LBP, and
a novel validated combined movements examination CONCLUSION: As LBP is a complex and multidimensional problem, the
integrative approach may help clinicians and researchers to better
understand and then to treat patients with non-specific LBP. The efficacy of
OMT treatments using an integrative approach in specific patients subgroups
should be objectively analyzed according to validated kinematic analyses in
future studies.
Keywords: Orthopedic manual therapy, low back pain, evidence based, classification systems, stratification care, kinematic analysis, integrative approach
