Study finds Spinal Adjustment Most Effective Intervention for Chronic Low Back Pain


A recent study published in Clinical Rehabilitation compared three treatment interventions with patients having non-specific low back pain. Four hundred forty three patients who reported having non-specific low back pain often or always over a 6 month period were evaluated for the study. Baseline data on pain related disability, pain-related use of medications, and demographic information was collected. Those who had any of the following were excluded: complicating factors such as neurological signs or symptoms, rheumatoid arthritis and other conditions, previous fractures, psychiatric disease, cognitive impairment, or pain-related litigation. The experimental group comprised 210 patients who met all of the eligibility requirements.

Patients were randomly assigned to one of three groups with 70 in each. The groups were: back school, individual physical therapy, and spinal manipulation. The back school group were given 15 hours of group education and exercises for one hour a day on 5 days a week spread over 3 weeks. Classes included training in back physiology and pathology, ergonomics and group exercises.

The physical therapy group received 15 hours of passive and active mobilization, active exercise, massage/treatment of soft tissue and proprioceptive neuromuscular facilitation. The emphasis was on education and active treatment by a physical therapist with the same amount of education and experience as the back school therapists.

The spinal manipulation group attended four to six weekly sessions of 20 minutes each for a total of 80 to 120 minutes of treatment. Treatment was aimed at restoring movement in the vertebral segments by direct and indirect mobilization and manipulation by chiropractors with at least 9 to 12 years of practice.

Two hundred five patients completed the study including 68 in the back school group, 68 in physical therapy, and 69 in spinal manipulation. All three groups reported a significantly lower rate of pain-related disability, subjective experience of pain, and low-back pain related use of medications at the end of the treatment period and after 12 months. Results were most striking for those assigned to the spinal manipulation group. Spinal manipulation provided more functional improvement than the other interventions at the end of the study program and at follow-up one year later as measured by lower scores on the Roland Morris Disability Scale. Their average score was 1.6 compared with 5.9 for the back school group and 5.3 for the physical therapy group. There was also less need for medications among this group than the others as measured by a 49% reduction in the need for pain medications in this group compared to a 23% drop in the back school group, and a 14% drop in the physical therapy group.

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