Prescriptive Mobilization Versus a Pragmatic Mobilization

This randomized clinical trial is designed to compare the outcomes of a prescriptively
applied non-thrust manipulation to a pragmatically applied non-thrust manipulation on
subjects with mechanical low back pain. The study has two primary aims. Specific Aim 1
examines immediate effect differences between a pragmatically applied localized non-thrust
manipulation versus a prescriptively applied, non-localized non-thrust manipulation in
subjects with mechanical low back pain. Specific Aim 2 examines longer-term differences
between a pragmatically applied localized non-thrust manipulation versus a prescriptively
applied, non-localized non-thrust manipulation in subjects with mechanical low back pain.
The investigators hypothesize there will be no differences between the two applied treatment
techniques in immediate and longer-term assessments.

Inclusion Criteria:

- Patients will need to be 18 years of age or older with mechanically producible LBP.
They will require a minimum Modified Oswestry Disability Index score of 20% and a
baseline pain score of >2.0/10 on the numeric analog scale for pain, and a within
session change (improvement during the visit) in pain and/or range of motion during
the assessment phase of the clinical examination.

Exclusion Criteria:

- The presence of any red flags (i.e., tumor, metabolic diseases, rheumatoid arthritis,
osteoporosis, prolonged history of steroid use, etc.), or signs consistent with nerve
root compression (reproduction of low back or leg pain with straight leg raise at
less than 45°, muscle weakness involving a major muscle group of the lower extremity,
diminished lower extremity muscle stretch reflex, or diminished or absent sensation
to pinprick in any lower extremity dermatome). Other exclusion criteria include prior
surgery to the lumbar spine and current pregnancy. Lastly, if patients are enrolled
in the study but do not receive a second outcome measure (follow up visit) they will
be excluded from the final analyses.