Is Spinal Manipulation Better Than Placebo for Low Back Pain Relief?

PainRelief.com Interview with:
James S Thomas, PT, PhD
Professor

Departments of Physical Therapy and Physical Medicine and Rehabilitation
Director of Motor Control Laboratory
Virginia Commonwealth University
Departments of Physical Therapy and Physical Medicine and Rehabilitation
Director of Motor Control Laboratory
Virginia Commonwealth University
Richmond, VA 23298

Dr-James-Thomas
Dr. Thomas

PainRelief.com:  What is the background for this study?

Response: While there are numerous studies on spinal manipulation which is typically defined as  high velocity short amplitude thrust procedure to treat a hypomobile vertebral segment, there are very few studies that examine spinal mobilization (typically described as non-thrust or as a muscle energy technique). There are even fewer studies on the comparative effectiveness of these interventions. 

Accordingly, the RELIEF study was designed to provide a rigorous examination of the comparative effectiveness of the two most common manual therapy techniques for treating low back pain (i.e., manipulation versus mobilization) compared to an effective placebo (i.e., Sham Cold Laser).

PainRelief.com: What are the main findings?

Response: Relative to the placebo group, there was no difference in the change in pain or disability for either spinal manipulation or mobilization. 

PainRelief.com: What should readers take away from your report?

Response:  Neither manipulation or mobilization are particularly effective interventions for chronic low back pain.  

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Chronic low back pain is a serious and costly public health problem and this study indicates that future research should examine novel interventions to reduce pain and disability in this cohort.

PainRelief.com: Is there anything else you would like to add? Any disclosures?

Response: An interesting aspect of this study is that cohort was, on average, 25 years of age with a duration of symptoms of 6 years. Most of the cohort developed back pain in highschool and while they report mild to moderate pain and relatively low levels of disability, thiss pain continues to disrupt their lives. As part of hte RELIEF study, we examined biomechanical and neurophysiological changes in response to manual therapies as well as compared to healthy controls. Preliminary analyses indicate significant biomechanical changes in trunk behavior even in a relatively young population. These findings will be submitted for publication in near future.

Citation:
Thomas JS, Clark BC, Russ DW, et al. Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(8):e2012589. doi:10.1001/jamanetworkopen.2020.12589

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