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COTTINGHAM and MAITLAND, Christie Clinic Association, Department of Sports Medicine and Physical Therapy, Rantoul, IL USA write that it is not common for physical therapists to have difficulty in treating certain people with chronic idiopathic low back pain. The authors present a 3-paradigm model of intervention for adaptation to the treatment of difficult low back pain cases.



: The model is composed of: 1) relaxation paradigm with pain modulation procedures 2) corrective paradigm with manual techniques and exercise to correct faulty biomechanical alignment(s) such as pelvic asymmetry and 3) integrative paradigm, with guided movement/mobilisation techniques for improving overall posture and movement patterns. In order to illustrate the 3-paradigm approach, the case study is presented of a young adult with chronic low back pain correlated with unilateral innominate bone rotation. The patient received a corrective (sessions 1-3) and integrative treatment protocol (sessions 4-6) composed of Rolfs method of soft tissue mobilisation and Alexander system of guided movement awareness techniques. Prior to and following each session and following a 4-week follow-up, the patient was assessed for sacroiliac joint pain using compression, anterior ration of the innominate bones, pelvic angle while standing and vagal tone. Both the subjects self-reports of pain and the therapists visual analysis of sit-to-stand movement were noted.


The corrective paradigm protocol of soft tissue mobilisation and exercise was unsuccessful in eliminating the individuals assessed anterior rotation of the innominate bone and associated low back pain for more than 1 or 2 days following treatment. It was only following the implementation of a third paradigm movement/mobilisation protocol did the person begin to show sustained improvement through a 4-week follow-up.


The authors discuss interpretations of the results, appropriate corrective and integrative protocols and physiological mechanisms.


Cottingham JT and Maitland J. A three-paradigm treatment model using soft tissue mobilisation and guided movement-awareness techniques for a patient with chronic low back pain: a case study. J Orthop Sports Phys Ther 26(3): 155-67. Sep 1997.


In view of the generalised and miserable epidemic of back pain amongst the majority of adults in developed countries, the above report demonstrates how important re-education and mobilisation are in successful therapeutic treatment. Please, therapists, write in with your results.

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