The effectiveness of manual therapy and proprioceptive neuromuscular facilitation compared to kinesiotherapy: a four-arm randomized controlled trial

Eur J Phys Rehabil Med. 2021 Apr;57(2):280-287. doi: 10.23736/S1973-9087.21.06344-9. Epub 2021 Mar 2.


Background: Low back pain (LBP) has a negative impact on patients' life, not only from the physical point of view, but also in terms of psychic, social and economic wellbeing. The increasing costs of treatment and health care encourage the search for the most effective methods of treatment.

Aim: The aim of the study was to determine whether the use of combined therapy consisting of manual therapy and proprioceptive neuromuscular facilitation (PNF) is more effective than the use of manual therapy techniques, PNF or traditional kinesiotherapy as single methods in the treatment of LBP.

Design: A four-arm RCT.

Setting: Rehabilitation Department of Hospital in Parczew (Poland).

Methods: The study was designed as four-arm randomized comparative controlled RCT and conducted on a group of 200 patients aged 27-55y. (44.9±9.2 years). The patients were randomly divided into four 50-person groups: 1) group A - manual therapy; 2) B - PNF; 3) C - manual therapy and PNF; and 4) group D - traditional kinesiotherapy and control group. Pain intensity was measured using VAS and Laitinen's questionnaire. Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS).

Results: There was a statistically significant difference in pain reduction (VAS Scale) between Group C (4.8 points) and Group D (3.9 points). In all the groups there was a statistically significant reduction in a degree of disability as measured by the ODI. A level of functional capabilities (BPFS) increased significantly only in Group C (8.8 points) as compared to Group D (5.7 points).

Conclusions: All the evaluated methods caused pain reduction which lasted for at least 2 weeks after the end of treatment. The degree of disability as measured by ODI lowered evenly in all groups. Patients' functional ability assessed with BPFS improved significantly in the group treated with combined therapy (manual therapy and PNF) as compared to the group of traditional kinesiotherapy.

Clinical rehabilitation impact: The therapy consisting of manual therapy and the PNF method seemed to be more effective than the traditional kinesitherapy in improving functioning of patients with non-specific low back pain.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Combined Modality Therapy
  • Disability Evaluation
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • Musculoskeletal Manipulations / methods*
  • Pain Measurement