Table 2 Treatment interventions

• 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

• 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

• 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)

• 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