Effects of individualized directional preference management with advice vs. advice alone for reducible discogenic pain.

Man  Ther  Jun; 2016

This interesting study (secondary analysis of a RCT) assessed whether DP guided management (10 sessions with a PT) and advice was more effective than advice alone (2 sessions) in a group of patients with back & leg pain.
The conclusion suggests those with reducible disc lesions are helped more thru 10-weeks of DP exercise than with advice alone. 

These results however were not sustained and though pain-relief was noted thru 10weeks there were no differences in ‘activity limitations’ or between groups when assessed at long-term follow up. So it was effective in giving rapid, albeit brief pain-relief…..when compared to nothing!
Studies of this type (comparing relatively ‘elaborate’ interventions to extremely minimal ones) always beg the question: shouldn’t the “response” be monumentally better vs only marginally better (and not just short-term) IF in fact the treatments were truly effective?
Ostensibly 10 PT sessions would likely be 10 times the cost of 2 and the benefit of short term pain reduction with NO difference in activity limitations or long-term improvement is troublesome. This especially considering DP is proffered as not only a pain-modifying activity (requiring very intense and elaborate training for the practitioner and efficient compliance from the patient) but also, as the name implies: a ‘reducible’ disc treatment.
Of course natural attrition of pain and self-healing are constant activities of living organisms but we’d like to imagine our interventions make greater differences than to just be “coincidental passengers” with innate.
Comparisons of Chiropractic and exercise to Mackenzie DP have yet to establish superiority….or even dramatic advantages over ‘standard-of-care’ but it certainly warrants inclusion in our treatment arsenal and assessing for a DP is better done than not in most cases.

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