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Table 2

Treatment interventions

InterventionSpinal Manipulative Therapy (SMT)Exercise Therapy (ET)
• 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
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