Spinal manipulation, mobilizations: ineffective for chronic low back pain

  • Thomas JS & al.
  • JAMA Netw Open
  • 3 Aug 2020

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Neither spinal manipulation nor spinal mobilization are effective at reducing chronic low back pain (LBP).

Why this matters

  • Although studies suggest that these manipulative therapies are effective at reducing subacute LBP, research on their efficacy in chronic LBP has produced mixed results.

Study design

  • Randomized, placebo-controlled RELIEF trial.
  • 162 people aged 18-45 years with chronic LBP received spinal manipulation (n=54), spinal mobilization (n=54), or sham cold laser therapy (placebo; n=54).
  • Numerical Pain Rating Scale used for pain scores and Roland-Morris Disability Questionnaire used for disability score.
  • Funding: NIH.

Key results

  • Mean length of chronic pain was 6.2 years.
  • No significant difference between groups in change in pain scores:
    • Spinal manipulation vs spinal mobilization: 0.24 (P=.45).
    • Spinal manipulation vs placebo: −0.03 (P=.92).
    • Spinal mobilization vs placebo: −0.26 (P=.39).
  • No significant difference between groups in change in disability scores:
    • Spinal manipulation vs spinal mobilization: −1.00 (P=.14).
    • Spinal manipulation vs placebo: −0.07 (P=.92).
    • Spinal mobilization vs placebo: 0.93 (P=.17).

Limitations

  • Results may not apply to adults aged >45 years.