Spinal manipulation plus exercise and advice appears effective in the short term for chronic back-related leg pain

Patients with chronic back-related leg pain (BRLP) may benefit in the short term from spinal manipulation plus home exercise and advice, according to a new study.

Researchers performed a prospective, controlled trial at 2 U.S. research centers from 2007 to 2011 to examine whether spinal manipulative therapy plus home exercise and advice reduced short- and long-term pain in patients with BRLP compared with home exercise and advice alone. Patients who were 21 years of age or older and had had BRLP for at least 4 weeks were assigned to receive 12 weeks of spinal manipulation plus home exercise and advice or home exercise and advice alone. The study's primary outcome was BRLP as rated by patients at 12 and 52 weeks, while secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. Patients assigned to spinal manipulative therapy were allowed up to 20 visits with a chiropractor. Home exercise and advice consisted of four 1-hour visits with a chiropractor, exercise therapist, or personal trainer during the 12-week intervention. The study results were published in the Sept. 16 Annals of Internal Medicine.

One hundred ninety-two patients were enrolled in the study, most of whom had chronic BRLP. Of these, 191 (99%) had follow-up data at 12 weeks and 179 (93%) had follow-up data at 52 weeks. Ninety-eight percent of the patients in the spinal manipulation group and 91% of patients in the home exercise and advice only group attended their prescribed treatment visits. At 12 weeks, spinal manipulation plus home exercise and advice had a clinically important advantage for relieving leg pain compared with home exercise and advice alone (difference, 10 percentage points; 95% CI, 2 to 19 percentage points; P=0.008). However, this advantage was not present at 52 weeks (difference, 7 percentage points; 95% CI, −2 to 15 percentage points; P=0.146). Although almost all of the secondary outcomes showed more improvement with spinal manipulation plus home exercise and advice at 12 weeks, sustained improvements at 52 weeks persisted for only global improvement, satisfaction, and medication use.

The authors noted that neither patients nor clinicians could be blinded in this study and that the study was not designed to determine whether spinal manipulation alone was effective, among other limitations. However, they concluded that spinal manipulation added to home exercise and advice is “a safe and effective conservative treatment approach, resulting in better short-term outcomes than [home exercise and advice] alone,” in patients with subacute and chronic BRLP. They called for future studies that directly compare manual therapy with common medical treatments and examine cost-effectiveness, as well as additional qualitative studies to help individualize treatment.