Manipulative Therapy Ineffective for Chronic Low Back Pain

James Thomas, PhD

Compared to placebo treatment, there was no difference in the reduction of low back pain and disability for those who underwent spinal manipulation or spinal mobilization.

The findings suggested spinal manipulation and spinal mobilization were both ineffective interventions for young adults with mild to moderate chronic low back pain.

James Thomas, PhD, and colleagues conducted a single-blinded, placebo-controlled randomized clinical trial to evaluate the comparative effectiveness of spinal manipulation and spinal mobilization at reducing pain and disability compared with a placebo control group.

The team randomized patients in a 1:1: ratio into 1 of 3 groups. In group 1, patients received spinal manipulation treatment 2 times per week for 3 weeks. Patients in group 2 received spinal mobilization treatment 2 times per week for 3 weeks. Those in the placebo group received sham cold laser treatment 2 times per week for 3 weeks.

For spinal manipulation treatment, participants were placed in a side-lying position facing the clinician with the more painful side facing upward. The clinician flexed the participant’s hips and knees to induce lumbar spine flexion until they felt the spinous process of the vertebrae begin to move. The participant was then rotated to their torso opposite to the side they were lying on until they felt rotation. The clinician added thrust to the shoulder and pelvis which resulted in a rotation force. Treatment was complete if an audible pop occurred. If not, the treatment was attempted again with a maximum of 2 attempts per side.

During spinal mobilization treatment, the participant was positioned the same way as during spinal manipulation. A clinician put 1 hand on the anterior should and 1 on the posterior pelvis. The participant was told to gently push the shoulder and pelvis into the clinician’s hands. The participant held the contraction for a minimum of 7 seconds with a maximum of 60 seconds. If an audible pop occurred or the clinician noticed a release in tissue tension, treatment was considered complete.

In the placebo group, a sham laser was delivered over the painful region. An insignificant amount of light energy or heat was delivered.

The investigators randomized 162 participants with a mean age of 25 years old, a majority of whom were women (57%), with chronic low back pain (mean NPRS sore, 4.3 on a scale of 1-10; higher scores indicated more pain). Of the participants, 54 were randomized into each group. The team noted no significant group differences for sex, age, BMI, duration of low back pain symptoms, depression, fear avoidance, current pain, average pain over the last 7 days, and self-reported disability.

For the primary endpoint, there was no significant difference in change in pain scores between spinal manipulation and spinal mobilization (.24; 95% CI, -.38 to .86; P=.45), spinal manipulation and placebo (-.03; 95% CI, -.65 to .59; P=.92), or spinal mobilization and placebo (-.26; 95% CI, -.38 to .85; P=.39). There was also no significant difference in change in self-reported disability scores between spinal manipulation and spinal mobilization (-1; 95% CI, -2.27 to .36; P=.14), spinal manipulation and placebo (-.7; 95% CI, -1.43 to 1.29; P=.92), or spinal mobilization and placebo (.93; 95% CI, -.41 to 2.29; P=.17).

“We conclude that these manipulative therapy techniques do not appear to be effective for chronic low back pain, at least among relatively young individuals with mild to moderate back pain,” Thomas and the team concluded.

The study, “Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain,” was published online in JAMA Network Open.