Does the addition of manual therapy to exercise therapy improve pain and disability outcomes in chronic low back pain: A systematic review
Abstract
BACKGROUND
Low back pain (LBP) is a common musculoskeletal problem and the leading cause of disability worldwide. Manual therapy and exercise therapy are used by physiotherapists to treat LBP. The evidence base for exercise is strong, however less so for manual therapy. We investigated whether manual therapy in addition to exercise provides improvements in pain and disability outcomes over exercise alone for LBP.
METHODS
A PRISMA guided systematic review protocol was developed. PubMed, Ovid and Web of Science were searched for randomised controlled trials (RCTs) which compared manual therapy plus exercise with exercise alone for LBP patients. Participants consisted of adults and older adults suffering from chronic back pain for over three months, recruited by researchers following examination by a health professional. Exercise prescriptions consisted of strengthening, stretching and stabilisation exercises. Manual therapies included spinal manipulation, massage, soft tissue mobilisation, myofascial release and muscle energy technique. The main outcome measures were pain (VAS, The McGill Pain Questionnaire) and disability (ODI, Quebec Back Pain Disability Scale). Secondary outcome measures included quality of life, flexibility, strength, spinal mobility, satisfaction.
RESULTS
Ten studies met the inclusion criteria: eight reported pain and/or disability improvements with the addition of manual therapy, two reported no benefit.
CONCLUSIONS
This systematic review found that…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Chaos and quantum thermalization
- The Dalton quantum chemistry program system
- Cord Blood Leptin and Adiponectin as Predictors of Adiposity in Children at 3 Years of Age: A Prospective Cohort Study
- Quantitative metabolomics by H-NMR and LC-MS/MS confirms altered metabolic pathways in diabetes
- Stable adiabatic quantum batteries
- A novel self-lipid antigen targets human T cells against CD1c(+) leukemias
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.