Research: low back pain

[highlight2]RESEARCH PAPER
The information replicated below concerns worldwide studies related to Chiropractic. Putney Chiropractic did not conduct the original research and only wishes to share issues with you that you may find interesting and relevant.[/highlight2]

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The May 2009 report by the National Institute of Clinical Excellence provides full support for Chiropractic adjustments (referred to as manipulation) in the treatment of low back pain.

Manual therapy
The manual therapies reviewed were spinal manipulation (a low-amplitude, high-velocity movement at the limit of joint range that takes the joint beyond the passive range of movement), spinal mobilisation (joint movement within the normal range of motion) and massage (manual manipulation or mobilisation of soft tissues). Collectively these are all manual therapy. Mobilisation and massage are performed by a wide variety of practitioners. Manipulation can be performed by chiropractors and osteopaths, as well as by doctors and physiotherapists who have undergone specialist postgraduate training in manipulation.

The NICE  recommendation is ‘consider offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks’

Not recommended
Other forms of treatment that are not recommended, commonly used in some physiotherapy clinics are: laser therapy, interferential therapy, therapeutic ultrasound, transcutaneous electrical nerve simulation (TENS), lumbar supports or traction.

The research
The United Kingdom back pain exercise and manipulation (UK BEAM) trial (UK Back pain exercise and manipulation (UKBEAM) Trial Team., 2004) aimed to estimate the effectiveness of adding exercise, spinal manipulation to best usual care in general practice. Patients recruited from participating centres had to be aged 18-65 and have had pain everyday for the 28 days before randomisation (or 21 out of 28 days before randomisation and 21 out of 28 days before that). They also had to agree to avoid physical treatment other than trial treatments for 3 months. Exclusion criteria included cancer, osteoporosis, ankylosing spondylitis, cauda equina compression, previous spinal surgery, anticoagulant treatment and severe cardiovascular disease or inadequately controlled hypertension.

A total of 1,334 patients were included in the study, with 353 randomised to a manipulation group and 338 to a ‘Best Usual Care’ control group. All patients received advice to continuing normal activities and avoiding rest, and copies of The Back Book were made available to them. Patients in the spinal manipulation package group received treatment using techniques agreed by professional representatives of chiropractic, osteopathy and physiotherapy following open consultation in the UK. Following initial assessment, manipulators chose from the agreed manual and non-manual treatment options. High-velocity thrusts were used on most patients at least once.

Patients were invited to attend up to eight 20-minute sessions, if necessary over 12 weeks. Patients in the control group (the best care alone group) only received the advice everyone was given. Results showed that relative to “best usual care”, spinal manipulation improved back function by a small to moderate margin at 3 months and by a smaller but still significant margin at 1 year. It also improved disability and pain, and general physical health. This was a high quality RCT with a very low risk of bias