The Change in the Diffusion of Water in Normal and Degenerative Lumbar Intervertebral Discs Following Joint Mobilization Compared to Prone Lying Paul F. Beattie, Jonathan W. Donley, Cathy F. Arnot, Ronald Miller
In Journal of Orthopaedic & Sports Physcal Therapy 2009;39(1):4-11
STUDY DESIGN: Prospective, repeated measures obtained under treatment and control conditions.
OBJECTIVES: The purposes of this study were to provide preliminary evidence regarding the immediate change in the diffusion of water in the nuclear region of normal and degenerative lumbar intervertebral discs (IVDs) following a single session of lumbar joint mobilization, and to compare these findings to the immediate change in the diffusion of water following a 10-minute session of prone lying.
BACKGROUND: There is conflicting evidence regarding the effectiveness and efficacy of lumbar joint mobilization. Increased knowledge of the physiologic effects of lumbar joint mobilization can lead to refinement of its clinical application.
METHODS AND MEASURES: A total of 24 people (15 males and 9 females), ranging in age from 22 to 58 years, participated in this study. All subjects had a history of activity-limiting low back pain. Diffusion-weighted magnetic resonance images (DW-MRIs) were obtained immediately before and after a 10-minute session of lumbar joint mobilization. At least 1 month later, a second session was performed in which DW-MRIs were obtained immediately before and after a 10-minute session of prone lying.
RESULTS: Following lumbar joint mobilization, a significant increase (P = .002) in the mean values for diffusion of water was observed within degenerative IVDs at L5-S1 (22.2% increase; effect size, 0.97). Degenerative IVDs at L1-2 to L4-5 and normal IVDs at L1-2 to L5-S1 did not demonstrate a change in diffusion following joint mobilization. Prone lying was not associated with a change in diffusion for normal or degenerative IVDs.
CONCLUSIONS: The stimulus provided by lumbar joint mobilization may influence the diffusion of water in degenerative IVDs at L5-S1; however, these are preliminary findings and the relationship of these findings to pain and function needs further investigation.
LEVEL OF EVIDENCE: Therapy, level 5.
KEY WORDS: back pain, lumbar disc disease, lumbar spine, manual therapy, physical therapy
Clinical Implications: The stimulus provided by lumbar joint mobilization may influence
the diffusion of water in degenerative IVDs at the L5-S1 level.
Cautions: These findings are preliminary and it is not known if they are reproducible in other samples. The relationship between these findings and symptoms of low back pain is not known and must be studied further.
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