Comfort during side posture lumbopelvic manipulation in a low back pain population - effects of a typical versus modified flexed lumbopelvic position

Sep 29, 2026

Uploaded by Ben

Study objective evaluates how participant positioning affects immediate comfort when delivering spinal manipulation in individuals with low back pain. A randomized crossover trial recruited adult volunteers with low back pain from a chiropractic college clinic, receiving standard side posture lumbopelvic manipulation versus a modified flexed lumbopelvic position with increased hip and lumbopelvic flexion. Comfort was self-reported on a 0–10 scale; paired comparisons used minimal clinically important difference and additional exploratory analyses of within-person comfort differences. No overall comfort difference emerged, though some individuals preferred the standard position.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Keywords

Background

Low Back Pain burden and prevalence

Conservative and nonpharmacological management

Spinal manipulation and clinical prediction rules

Wang et al. Chiropractic & Manual Therapies (2026) 34:1 [https://doi.org/10.1186/s12998-025-00621-z](https://doi.org/10.1186/s12998-025-00621-z) Chiropractic & Manual Therapies RESEARCH Open Access Comfort during side posture lumbopelvic manipulation in a low back pain population—effects of a typical versus modified flexed lumbopelvic position: a crossover randomized control trial Simon Wang 1*, Erinn McCreath Frangakis 1, Martha Funabashi 1,2 and Sheilah Hogg-Johnson 1,3,4 Abstract Background Literature on low back pain (LBP) treatment suggests not all LBP is the same and patients with extension-or flexion-related LBP may benefit from different strategies. This study’s objective was to evaluate the effect of participant positioning when delivering spinal manipulation on reported immediate comfort, in individuals with LBP. Methods This a randomized crossover trial. Volunteer adult participants with LBP were recruited from a chiropractic college campus clinic to receive two procedures in random order: 1. Standard side posture lumbopelvic manipulation (SPLM) and 2. Modified flexed lumbopelvic manipulation. The modified position was similar to the standard, but with increased hip and lumbopelvic flexion. Participants were not blinded. The primary outcome of self-reported comfort was recorded using a 0–10 scale. Paired t-tests were used to compare mean comfort scores, and a minimal clinically important difference of 2.0 was used. Secondary analysis examined correlations between comfort during active range of motion (AROM) and the two SPLM procedures. An exploratory analysis comparing within-participant differences was examined. All reported harms were mild in nature (e. g. discomfort) . Results Forty participants were recruited (mean 25.5 years of age, 75% female) . 20 participants started with the Standard SPLM and 20 started with the Modified Flexed SPLM. No differences in comfort were found between the Standard SPLM (N = 40) versus Modified flexed SPLM (N = 40),(mean (SD) = − 0.01 (2 . 3), Effect Size Cohen’s d = − 0.004 95% CI (− 0 . 32, 0 . 32)) . No correlations were found between the comfort during AROM and the two SPLM procedures. Observing within-participant differences for individual comfort, 14 participants had a clinically significant difference ≥ 2. Specifically, 6 participants had lower scores with Standard SPLM and 8 participants had lower scores with Modified flexed SPLM. *Correspondence: Simon Wang [swang@cmcc.ca](swang@cmcc.ca) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ([http://creativecommons.org/publicdomain/zero/1.0/](http://creativecommons.org/publicdomain/zero/1.0/)) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Wang et al. Chiropractic & Manual Therapies (2026) 34:1 Page 2 of 10 Conclusion Comparing comfort during a Modified flexed SPLM to the Standard one revealed no difference fora population with LBP. However, some individuals did demonstrate a comfor

FAQs

What was the main goal of the study?

To evaluate whether the way participants were positioned during spinal manipulation changed their immediately reported comfort in people with low back pain.

What were the two manipulation positions compared?

Standard side posture lumbopelvic manipulation was compared with a modified flexed lumbopelvic position that increased hip and lumbopelvic flexion.

Did the standard and modified positions differ in comfort for the overall group?

No overall differences in comfort were found between the standard and modified flexed lumbopelvic positions.

Did any participants show a meaningful preference?

Yes. When within-participant differences were examined, a clinically significant difference (≥2 on the 0–10 scale) was observed in 14 participants, with some scoring lower under each position.

Sep 29, 2026

Uploaded by Ben