Spinal manipulation and exercise was better than ultrasound and exercise for patients with chronic low back pain

Abstract

What are the short-and long-term effects of spinal manipulation in patients with chronic low back pain? Randomised controlled trial. Outpatient physiotherapy department in UK. 120 people, aged 18–55, with non-specific low back pain of greater than 3 months duration. Participants were excluded if they had a history of prior treatment including manipulation, chiropractic, osteopathy, and ultrasound, or were receiving disability benefit as a result of LBP. Both groups were given a written set of exercises, chosen by the physiotherapist for each individual. In addition, one group received high velocity thrust manipulation in side-lying (on average four sessions) and the other group received therapeutic ultrasound (1 MHz, continuous pattern, on average six sessions). Pain intensity (measured on a visual analogue scale, 0–100 mm), functional disability (Oswestry questionnaire, 0–100%), lumbar movements (modified Schober's test), and muscle endurance (measured by surface electromyography) were measured before treatment, at the end of treatment program, and 6 months after randomisation. Participants in the manipulation/exercise group demonstrated a significantly greater reduction in pain intensity (mean between-group difference 16.4, 95% CI 6.1 to 26.8) and functional disability (mean-between group difference 7.8, 95% CI 2.4 to 13.2), as well as improved lumbar flexion (mean between-group difference 9.4 mm, 95% CI 5.5 to 13.4) and extension (mean between-group difference 3.4 mm, 95% CI 1.0 to 5.8 ( p < 0.01 in all instances). After six months the manipulation/ exercise group still demonstrated greater benefit than those in the ultrasound/exercise group for pain (mean betweengroup difference 15.1, 95% CI 7.55 to 22.64) and disability (mean between-group difference 5.2, 95% CI 2.63 to 7.81). Data for Month 6 are provided by the author because numbers reported in Table 3 in the published paper are incorrect. Manipulation and exercise showed greater improvement compared to ultrasound and exercise for participants with chronic low back pain, both at the end of treatment and at six months follow-up.