Man­ual ther­apy is one of the most thor­oughly researched treat­ment meth­ods for low back pain.  Still, this is a very tricky area to study.

Here are some of the pit­falls that con­front researchers in this area:

• What par­tic­u­lar man­ual ther­apy tech­niques are being tested?  Are they being tested alone or in combination?

• By what diag­nos­tic cri­te­ria are patients being selected?
• Are the prac­ti­tion­ers in the study pro­vid­ing the same for­mu­laic treat­ment for each patient, or do they use their expe­ri­ence to deter­mine the best com­bi­na­tion of meth­ods for each person?
• What out­come mea­sures are being tested?  Are we look­ing at pain lev­els?  Func­tion­al­ity? Over­all qual­ity of life?
• What other treat­ment inter­ven­tions can study sub­jects receive?  Are they tak­ing pain med­ica­tion?  Per­form­ing exercises?

Those of us who work day in and day out with man­ual ther­apy are con­fi­dent that these tech­niques offer extra­or­di­nary value.  And there are many, many sci­en­tific arti­cles that have been pub­lished that lend sup­port to this point of view.

But the method­olog­i­cal com­pli­ca­tions make it a chal­lenge to sci­en­tif­i­cally prove what we think we know.  The dozens (if not hun­dreds) of research projects that have stud­ied the effect of man­ual ther­apy on low back pain are still evolv­ing the answer to these key questions –

• can man­ual ther­apy help peo­ple with low back pain?
• what are the best treat­ment methods?
• how should man­ual ther­apy be com­bined with other known treat­ment options, such as ther­a­peu­tic exercise?

Recently, a very well designed research study was pub­lished which adds even more to our body of knowl­edge.  It really com­pared apples to apples.

Two treat­ment groups were com­pared.  Both groups engaged in a ther­a­peu­tic exer­cise pro­gram known to be help­ful for those with back pain.  The dif­fer­ence between the two groups was that one group received a pro­gram of man­ual ther­apy care before ini­ti­at­ing their ther­a­peu­tic exer­cise pro­gram.  The con­trol group received a pro­gram of “sham” care before ini­ti­at­ing their exer­cise program.

The idea was to see if pro­vid­ing man­ual ther­apy helped alle­vi­ate pain and restore enough order to the spine that the patient could engage in an exer­cise pro­gram more effectively.

The results con­firmed the value of spinal mobi­liza­tion and manip­u­la­tion.  The group receiv­ing treat­ment had lower lev­els of pain and dis­abil­ity dur­ing the 4–8 week treat­ment period and for up to 6 months thereafter.

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