A research article was posted in Pain Journal in July 2018 that describes a randomized trial for treating adolescents with lower back pain. The trial compared spinal manipulation plus exercise with exercise alone. Similar studies have been performed in the past, but this is the first that I've personally seen where it is studied in an adolescent population. Here is the Abstract of the article, followed by the link to the entire article (which is free for the full text).
Low back pain (LBP) is common in adolescence, but there is a paucity of high-quality research to inform care. We conducted a multicenter randomized trial comparing 12 weeks of spinal manipulative therapy (SMT) combined with exercise therapy (ET) to ET alone. Participants were 185 adolescents aged 12 to 18 years with chronic LBP. The primary outcome was LBP severity at 12, 26, and 52 weeks. Secondary outcomes included disability, quality of life, medication use, patient- and caregiver-rated improvement, and satisfaction. Outcomes were analyzed using longitudinal linear mixed effect models. An omnibus test assessing differences in individual outcomes over the entire year controlled for multiplicity. Of the 185 enrolled patients, 179 (97%) provided data at 12 weeks and 174 (94%) at 26 and 52 weeks. Adding SMT to ET resulted in a larger reduction in LBP severity over the course of 1 year (P = 0.007). The group difference in LBP severity (0-10 scale) was small at the end of treatment (mean difference = 0.5; P = 0.08) but was larger at weeks 26 (mean difference = 1.1; P = 0.001) and 52 (mean difference = 0.8; P = 0.009). At 26 weeks, SMT with ET performed better than ET alone for disability (P = 0.04) and improvement (P = 0.02). The SMT with ET group reported significantly greater satisfaction with care at all time points (P ≤ 0.02). There were no serious treatment-related adverse events. For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a 1-year period, with the largest differences occurring at 6 months. These findings warrant replication and evaluation of cost effectiveness.
https://journals.lww.com/pain/fulltext/2018/07000/Spinal_manipulation_and_exercise_for_low_back_pain.13.aspx
This paper echos other well done research articles and also current best practices in the chiropractic profession. The combination of spinal manipulation (adjustments in the chiropractic lingo) plus therapeutic exercise leads to the best outcomes for people with back pain. Treatment satisfaction was also higher in the group receiving manipulation plus exercise, meaning that patients like it! Remember, evidence based practice consists of three components:
- Current supporting evidence and research for treatment
- Doctor/practitioner experience
- Patient preference
All three must be taken into account when treating a patient, whether that is for back pain, ankle sprains, headaches, or even cancer. So the fact that the researchers took into account patient satisfaction with treatment was a big plus.
My personal conclusion is simple: if you are a patient with back pain or a practitioner who treats low back pain, now specifically in an adolescent population, you should absolutely consider adding spinal manipulation into your treatment plan in addition to therapeutic exercise. If you don't, you could be missing out on an important piece to your care.
-Dr. Levi