Physical Therapy or Manipulation for Chronic Low Back Pain?

The answer to chronic low back pain is NOT nothing. Choices for care include chiropractic manipulation or physical therapy.

I know that it seems intuitive that rehab exercises for chronic low back pain would be a good idea. However, I can’t say that I’ve ever been completely on board with this idea. While not every case of chronic low back pain does well in our office, we do pretty darn well with the vast majority of cases that come through. From years of experience, I firmly believe that advanced soft tissue techniques in competent physicians’ hands combined with manipulation is one of the strongest tools for management of chronic low back pain.

Despite this, there is a belief that patients with chronic low back pain should go to physical therapy to get rehab exercises for his or her low back pain and many primary care physicians still continue to refer patients out for physical therapy.

Always happy to find out that my practice philosophy is not shared by my office alone, I present this particular article, looking at the outcomes of 12 weeks of treatment in 199 patients with chronic low back pain (defined as more than 6 weeks’ duration) using exercise versus manipulation.

Specifically, exercised consisted of high-dose, supervised low-tech trunk exercise. As a way of measuring outcomes, researchers looked at four motion parameters in the sagittal plane and two in the horizontal plane as well as the jerk index parameter.

The group that received manipulation changed in all of the parameters measured. In addition, the manipulation group had a smoother motion pattern (reduced jerk index) at the end of the study. The exercise group, however, only improved in half of the parameters measured and there were no improvements in the jerk index.

Based on this study, a patient with chronic low back pain would be much better off seeing a provider who can do spinal manipulation. Adding the aforementioned soft tissue techniques to manipulation gives you an even greater chance of finding relief where nothing else has helped.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.