An estimated 60-80% of people will suffer from low-back pain at least once in their lifetime. However, the treatment of chronic lower back pain is complex, and the outcome remains unpredictable. Doctors are advised to recommend that patients follow a program of active exercise to alleviate their symptoms. However, patients may be reluctant to do so because of their pain.
A recent study compared the effects of chiropractic treatment followed by exercise versus a placebo or 'sham' treatment followed by the same exercise. The researchers hypothesize that chiropractic adjustments – which are believed to induce an immediate analgesic effect – may enhance the benefits of exercise for patients with lower back pain.
The study involved patients with chronic, non-specific lower back pain. The first group received spinal adjustments plus active exercise therapy. The second group received a detuned ultrasound 'sham' treatment followed by active exercise. Both groups underwent eight treatment sessions over 4 to 8 weeks.
The analgesic effect of spinal adjustments were measured by evaluating pain intensity both before and immediately after each therapeutic session. Periodically, researchers also evaluated participants' disability, fear-avoidance beliefs, and erector spinae and abdominal muscle endurance (measured with Sorensen and Shirado tests).
The participants who received spinal adjustments experienced a better immediate analgesic effect, along with lower disability and a trend toward lower pain levels. The researchers concluded that manual therapy, immediately followed by active exercise, tends to induce a more significant decrease in pain reduction in patients with chronic lower back pain. These results confirm that chiropractic is an appropriate treatment for chronic low-back pain.
While exercise has long been a crucial component of chiropractic care, this study provides further evidence of the efficacy of combining exercise with chiropractic adjustments for relieving chronic pain.
Balthazard P, et al. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskeletal Disorders 2012; 13: 162. doi:10.1186/1471-2474-13-162.