Type
| • High velocity, low amplitude SMT preferred
| ET Visit
|
Self-care education
|
• Other manual therapies if needed
| • Supervised exercise
|
◦ Low velocity, low amplitude SMT or mobilization
|
◦ Aerobic warm up
|
◦ Flexion-distraction manipulation
|
◦ Drop-table assisted SMT
| ◦ Stretching (cat/camel, piriformis, hamstring, laying back rotation)
|
• Up to 5 minutes adjunct therapies to facilitate SMT:
|
◦ Light soft tissue massage, active and passive stretching, ischemic compression of tender points, ice and heat
| ◦ Strengthening (bridge, abdominal curl, back extension, side bridge, quadruped, and squats) with changes in body positioning and addition of labile surface (i.e., gym ball) for progressions
|
Home Exercise
|
• Instructions provided at treatment visits and supplemented by take home materials
|
Design & delivery format
| • Individualized: number of visits, spinal levels treated, SMT and manual therapy technique used and adjunct therapies determined by provider according to patient needs and tolerance
| ET Visit
|
• Supervised
|
• Individualized: number of visits, exercise progressions determined by provider
|
Home Exercise
|
• Unsupervised
|
Delivery method
| • One-on-one treatment visit
| ET Visit
|
• Treatment provided by licensed chiropractor
| • One-on-one exercise therapy visit
|
• Instructions and supervision provided by licensed chiropractor or exercise therapist
|
Home Exercise
|
• Instructions provided at treatment visits
|
• Instructions supplemented by take home materials (exercise photos, modified Back in Action[26] book)
|
Dose | • 8 to 16 treatment visits
| ET Visit
|
• 10 to 20 minutes per visit
| • 8 to 16 visits
|
• Maximum frequency: 2 times/week |
• 45 minutes per visit
|
◦ 10 minutes self-care education
|
◦ 5 minutes aerobic exercise warm up
|
◦ 30 minutes supervised exercise
|
▪ Stretching: 1 set; 3 reps
|
▪ cat/camel; 1 rep each side for other stretches
|
▪ Strengthening: 2 sets; 16 to 20 repetitions each exercise
|
Home Exercise
|
• Maximum frequency: 2 times/week |