Another article seeking to develop a clinical prediction rule (CPR) has been accepted for publication in the Journal of Orthopaedic and Sports Physical Therapy (JOSPT). Iverson et al found five predictors of success with lumbopelvic manipulation:
1. Difference in hip internal rotation (> 14 degrees)
2. Ankle dorsiflexion with knee flexed (>16 degrees)
3. Navicular drop > 3mm
4. No stiffness with sitting > 20 minutes
5. Squatting is the most painful activity
Pre-test probability of success with manipulation was 45%.
If a hip internal rotation difference of greater than 14 degrees was present, the likelihood of success with manipulation increased to 80%!
If any three of the five factors above were present, likelihood of success improved to 94%.
Keep in mind this is a study performed on 50 subjects with detailed criteria for inclusion. Validation studies will have to be performed, but think of this…
If I told you that from your clinical exam, the likelihood that you would experience a 50% decrease in your knee pain if I performed a lumbopelvic manipulation was 94% – would you want that treatment?
Practice standardization is the future of our profession – get on board.