It is well known that staying active is an important way to quickly recover from an episode of low back pain. Other studies have shown that chiropractic care is also effective at helping patients with back pain.
This current study was conducted over a 10-week period in Sweden, and it looked at the effectiveness of traditional stay-active treatment for lower back pain, versus that of stay active-care combined with manual therapy that included stretching and manipulation.
160 study subjects aged 20 to 55 years of age, employed, and with lower back pain of 3 months duration or less and no other significant medical conditions or complications entered the clinical trial. Subjects were randomly assigned to one of two groups, with 45% assigned to the reference (stay-active care) group, and 55% assigned to the experimental (stay-active care + manual therapy) group.
Stay-active treatment was given by 2 orthopedic surgeons and 8 physiotherapists to the reference group. This treatment consisted of:
- Patient education to encourage taking part in physical activities to stay fit.
- Prescribing sick leaves as short as possible, with medications prescribed when indicated.
- Offering muscle stretching and matching home exercises (41% received stretching).
The experimental group (stay-active therapy + manual care) received treatment from 2 GPs and 9 physiotherapists who had previously received 12 days of training in administering manual therapy. They used the stay-active approach noted above, and added manual therapy to their treatment, which included:
- Muscular Energy Technique (MET) diagnostic items included in the physical exam.
- Mobilization for pelvic dysfunction, with a lock maneuver administered gently according to MET procedure.
- Treatment with specific mobilization or lumbar thrust techniques based on exam results.
Steroid injections were allowed in 50% of the patients based on specific findings, with soft tissue stretching after parasacrococcygeal injections (injections to the base of the spine near the rectum). Auto-traction was used when indicated for cases of herniated disc.
Outcomes for both pain and 15 disability variables were measured using visual analog scales that rated pain or disability from none (0 mm) to maximum (100 mm). 12 of the disability items formed the Disability Rating Index, which measured such items as the ability to lift heavy items, to do heavy or light physical work, ability to participate in sports, to run, to get up from a sitting position, to dress (without help), to bend over a sink, to carry a bag, to climb stairs, to make a bed, to walk outdoors. The other 3 disability variables measured the ability to lie still, and to drive or ride in a car. The questionnaire also asked about medications taken.
A baseline measurement was obtained when patients entered the study, and outcomes were measured at 5 weeks and 10 weeks after treatment started. Treatment staff was blinded to the outcomes during the study period.
At the beginning of the study, the baseline results were the same for both groups. Pain scores decreased significantly with treatment over time for both groups. But because the experimental group had a slightly greater degree of baseline pain, when adjustments for herniations, age and sex were made, the experimental group experienced a faster rate in the decrease of pain during the last week of the study. The use of pain medication and nonsteroidal anti-inflammatory medications decreased at a similar rate in both groups over the period of the study.
At baseline, the experimental group tended to have slightly higher initial disability scores for all 15 variables than the reference group. By 5 and 10 weeks, the experimental group tended to have lower scores on all disability variables, and to have experienced a faster rate of improvement in the Disability Rating index, than the reference group.
Stay-active care combined with manual therapy provided greater pain relief during the last week of treatment and improved disability scores at 5 and 10 weeks, when compared with stay-active care alone. These study results are consistent with previous studies that have shown the higher effectiveness of manual treatment when compared with stay-active care treatment. The study authors theorize that this effectiveness is due to extension of the muscle spindles resetting input into the proprioreceptive system within the lower back, although the true mechanism is still unknown and needs further study.
The improved results with manual therapy would indicate that it should become a more generally used treatment option in the treatment of lower back pain than stay-active care alone.
Grunnesjo MI, Bogefeldt JP, Svardsudd KF, Blomberg SIE. A randomized controlled clinical trial of stay-active care versus manual therapy in addition to stay-active care: functional variables and pain. Journal of Manipulative and Physiological Therapeutics 2004;27:431-441.