Manual spine manipulation may provide more short-term low back pain relief than other methods

SAN FRANCISCO — Compared with mechanical-assisted manipulation and usual medical care, manual-thrust manipulation provided patients with more relief of low back pain in the short term, according to study data presented at the International Society for the Study of the Lumbar Spine Annual Meeting.

According to presenter Michael Schneider, MD, a manual-thrust manipulation technique provided better low back pain relief in patients after 4 weeks of treatment, but the difference in outcomes tapered off between the 3-month and 6-month follow-up.

“It seems the manual-thrust manipulation is doing something different than the mechanical manipulation, and it is doing better than the usual medical care group. At 3 to 6 months, this kind of tapers off,” Schneider said. “There are limitation to this [study]: we did not have a true sham or placebo group, [and] we cannot distinguish specific vs. nonspecific effects. But, this would lead to the recommendation that manual manipulation should be offered at least as a treatment option for sub-acute and acute low back pain.”

Schneider and colleagues conducted a randomized, controlled trial that included 107 patients with low back pain. Patients were randomly assigned to receive either mechanical-assisted manipulation, usual medical care or manual-thrust manipulation. Those in the mechanical-assisted manipulation or manual-thrust manipulation groups received treatment twice weekly during a 4-week period, whereas those in the usual medical care group attended three treatment visits during the same period of time. The researchers recorded outcome measures at baseline and at 4 weeks, 3 months and 6 months after treatment.

According to Schneider, the advantage of manual-thrust manipulation was statistically significant at 4 weeks compared with mechanical-assisted manipulation (disability = ‐8.1,

P = .009; pain = −1.4, P = .002) and usual medical care (disability = −6.5, P = .032; pain = −1.7, P < .001).

Additionally, a greater number of patients in the manual-thrust manipulation group experienced 30% to 50% reduction of Oswestry Disability Index scores than the other treatments. However, the differences were not statistically significant at the 3-month and 6-month follow-up period, Schneider said. – by Robert Linnehan

Reference:

Schneider M, et al. Paper #33. Presented at: International Society for the Study of the Lumbar Spine Annual Meeting; June 8-12, 2015; San Francisco.

Disclosure: Schneider reports receiving grant No. R00AT004196 from the National Center for Complementary and Alternative Medicine at the National Institutes of Health.