A double blinded, placebo controlled study entitled “Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better Long-Term Outcome?” was conducted by two medical doctors, with their results recently published in the journal SPINE. The objective of the study was to assess the effectiveness of spinal manipulation therapy (chiropractic adjustments) for the management of nonspecific low back pain.
Low back pain is the most common ailment world wide, experienced by 80% of the adult population. Chronic low back pain is defined as low back pain that persists for at least 12 weeks, and non-specific low back pain, is low back pain that is attributable to a recognizable, known specific pathology – this type of pain is experienced by 85% of patients in primary care. About 10% of those with non-specific low back pain go on to develop chronic, disabling low back pain. Preventative care is one way to reduce the long-term effects of low back pain.
One previous study had found that many patients with chronic low back pain who were treated with spinal manipulation felt improvement within two weeks and by the 12th treatment 75% of patients had improved. Another study saw that, when compared to patients who received no spinal manipulation, patients who had been treated with spinal manipulation had improved pain levels and a 66% reduction in their oswestry scores (a chart that rates severity of symptoms) over a period of 4 treatments.
In this most recent study, Dr. Senna and Dr. Machaly set out to discover if spinal manipulation therapy maintained for long periods of time is more beneficial in maintaining the desirable outcomes obtained after short-term treatment. Essentially, to see if maintenance care is effective at managing the symptoms of chronic, non-specific low back pain and the disability levels associated with this pain.
The study breaks down like this:
The patients, who were all between 20-60 years old with chronic, non-specific low back pain, were separated into three different groups.
Group 1: The Control Group
These patients received 12 sessions (3x week for 4 weeks) of sham (fake) spinal manipulation, using minimal force. After the first 4 weeks, the patients received continued to receive sham treatments at the rate of 1 treatment every 2 weeks, over the following 9 months.
Group 2: The Non Maintained Group
The patients in this group received standard spinal manipulation treatments (3x week for 4 weeks) for the first month, and then received sham treatments at the rate of 1 treatment every 2 two weeks for the next 9 months.
Group 3: The Maintained Group
The patients in group 3 received the same intensive period of standard spinal manipulation treatments of group two (3x week for 4 weeks) and also received standard manipulation treatments at the rate of 1 treatment every 2 weeks over the next 9 months.
Comparison Among the Three Groups
Patients in Group 2 and Group 3 (the two groups that received actual treatments) experienced significantly lower pain and disability scores when compared with the control group after the first phase of treatment – the intensive 4 weeks of receiving treatment 3x/week.
By the end of the second phase of treatment (after the 10 month period) patients with maintained spinal manipulation treatments (Group 3) had significantly lower pain and disability scores compared with patients from the non-maintained group (Group 2).
Change of Oswestry Disability Score
Patients in Group 2 and Group 3 (the two groups that received actual treatments) experienced significantly lower pain and disability scores when compared with the control group after the first phase of treatment – the intensive 4 weeks of receiving treatment 3x/week.
There were significant differences in the scores between maintained (Group 3) and non-maintained (Group 2) patients at the end of the 10 month period.
Change of Spinal Mobility
The patients who continued to received treatment (Group 3) increased their range of motion in their spinal flexion and lateral bending in the first phase (month 1) and continued to increase their range of motion in the second phase (months 2-10).
The patient’s who only received sham treatments after the first month (Group 2) had their spinal movement increased in the first phase only and actually decreased to near pre-treatment levels by the end of the second phase.
Conclusion
- Spinal manipulation therapy is an effective treatment for chronic non-specific low back pain.
- In order to obtain long-term benefits, maintenance spinal manipulation after the initial intensive period of manipulation is important.
- Periodic patient visits permit proper evaluation, detection and early treatment of any emerging problems, thus preventing future episodes of low back pain.