Acute Back Pain – Spinal Manipulation
Does it give lower back pain relief - or not?
If you have got acute back pain sack your chiropractor, don't bother with physiotherapy and throw your anti-inflammatory tablets in the bin. Go for a walk and take paracetamol instead. These were the sorts of headlines in the British newspapers recently.
The reason for such interesting headlines is a new piece of research that was published in the Lancet (1) in November. This study is a well designed Australian trial comparing different types of management for acute back pain (pain you have only had for a few weeks).
Here’s what they did:
They split 240 patients with acute back pain into four groups and gave them the following treatments:
- Group 1 Spinal manipulation and Diclofenac (an anti-inflammatory medication)
- Group 2 Placebo manipulation and Diclofenac (the placebo manipulation they used was sham ultrasound)
- Group 3 Spinal manipulation and placebo Diclofenac (a tablet that looked exactly the same as the real thing)
- Group 4 Placebo manipulation and placebo Diclofenac.
They then measured how long it took the individuals in each group to recover from the acute back pain, the amount of pain they felt, their function and how much disability they experienced.
The findings are absolutely fascinating. There was no difference at all between any of the groups. None of the treatments made the slightest difference. One thing really interesting did happen though, 11 patients taking placebo Diclofenac had unpleasant side effects!
So ...Manipulation doesn't work then?
Not exactly, the headlines don’t really tell you the whole story. The manipulation treatment was performed by physiotherapists. I have no problem with that, physiotherapists can manipulate as well as anyone when they are trained. However, physiotherapists also use a technique called mobilisation. This is different from the traditional type of back manipulation.
In this trail 95% of the manipulation patients actually received mobilisation treatment, only 5% received true back manipulation.
I really do believe that active treatment for acute back pain is much better than passive care (passive treatments are things someone else does to you, such as manipulation) so I was really pleased to see this research. However, it’s not really OK to dismiss spinal manipulation off the back of these findings – the jury remains out for me. The latest back pain guidelines suggest there may be a small benefit from manipulation in patients with acute back pain. We will have to wait a little longer to find out for sure.
In the meantime, try not to worry and follow these suggestions if you have acute lower back pain.
References
Hancock, M., Maher, P. C., Latimer, P. J., Prof Andrew, J. M., Cooper, M. C., Prof Richard, O. D., Spindler, M., & McAuley, P. J. "Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial", The Lancet, vol. 370, p. 1638.
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04-Jul-2008
