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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