Sub Acute Low Back Pain With Radiating Symptoms
Conditions
Keywords
Low back pain, Manual therapy, Physiotherapy, Decision making
Brief summary
This study evaluates the effectiveness of a specific manual therapy approach based on the Algo-K decision algorithm in patients with subacute low back pain radiating to the lower limb. Algo-K helps select the most suitable lumbar mobilization technique according to the patient's pain response. The experimental group will receive a five-minute targeted manual therapy in addition to standard physiotherapy, while the control group will receive a non-specific mobilization. The study aims to determine whether this algorithm-guided intervention leads to faster and greater improvement in pain and disability.
Detailed description
Subacute low back pain (LBP) with radiating symptoms is a common musculoskeletal disorder with a risk of chronicization. Manual therapy is often used in physiotherapy to treat LBP, but its effectiveness varies widely due to heterogeneous practices and lack of specificity. The Algo-K algorithm was developed to guide therapists in selecting the most appropriate mobilization technique based on patients' symptomatic responses during movement tests. This multicenter randomized controlled trial compares the effectiveness of a specific manual therapy guided by the Algo-K algorithm versus a non-specific manual therapy added to a standardized exercise-based physiotherapy program. Sixty adult patients with subacute LBP and radiating pain will be included. Participants will be randomly assigned to either: * Experimental group: 5 minutes of specific lumbar mobilizations based on the Algo-K decision tree; * Control group: 5 minutes of non-specific mobilization at a distant thoracic level. Both groups will receive the same standard physiotherapy care based on exercise and education, delivered over 12 sessions within a 60-day period. The primary outcome is the Oswestry Disability Index (ODI) score at 26-30 days. Secondary outcomes include pain intensity (Numeric Rating Scale), pain distribution (body diagram), and long-term disability (ODI at 52-60 days). The hypothesis is that the specific, patient-tailored manual therapy will improve functional outcomes and reduce pain more effectively than non-specific mobilization.
Interventions
PROCEDURESpecific Manual Therapy
Participants in this group receive a standardized physiotherapy program (exercise and education) plus 5 minutes of targeted lumbar postero anterior mobilizations. These mobilizations are selected using the Algo K decision algorithm, which guides the therapist to choose the most appropriate technique based on the patient's pain response during preliminary movement tests.
PROCEDURENon specific Manual Therapy
Participants in this group receive the same physiotherapy program, but the additional 5 minutes of mobilization are applied to the upper thoracic spine (T4-T7), away from the symptomatic lumbar region. This sham mobilization mimics the manual therapy without targeting the affected area or following the algorithm's logic.
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Masking description
Patients unaware of allocation ; sham mobilization in control arm
Intervention model description
2 groups, both of them will execute the same standard physiotherapy care based on exercise and education for 25 minutes for each session, randomly assigned 1:1. For the control group, they will have a 5 minutes postero-anterior mobilisation procedure on a upper thoracic vertebra For the interventional group, they will have a 5 minutes postero-anterior mobilisation procedure on a lumbar vertebra, determined by the algorithm
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Adults 18 65 y o * Sub acute low back pain (7 days - 3 months) with irradiation to one lower limb, pain 3 10/10 * Mechanically responsive pain * ODI \> 20 % and \< 80 % * Prescription ≥ 12 physiotherapy sessions (or un specified) * Able to complete 12 sessions in ≤ 60 days * Affiliated to French social security * Signed informed consent
Exclusion criteria
* Suspicion or history of serious pathology (cancer, systemic inflammatory disease, etc.) * Main complaint other than low back pain with irradiation * Prior spine or hip surgery (no time limit) / thoraco abdominal surgery \< 3 y * Central Sensitization Inventory ≥ 37 * HAD anxiety or depression sub score ≥ 8 * Planned lumbar infiltration during follow up * Pregnancy or breastfeeding * Legal protection (guardianship, custody, imprisonment)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Oswestry Disability Index (ODI, %) | Baseline day to 26-30 | Patient-reported disability (ODI French version) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Oswestry Disability Index (ODI, %) | day 52-60 /or visit 12 | Disability at end of follow-up |
| Pain intensity (numeric rating scale, 0-10) | Baseline day 26-30 ; day 52-60 /or visit 12 | Average pain last 24h |
| Pain topography (body diagram score) | Baseline day 26-30 ; day 52-60 /or visit 12 | Distal extension of symptoms |
Contacts
Primary ContactSebastien MARTIN, PT, MSc
Backup ContactRomain ARTICO, PhD
Outcome results
None listed