What is the effect of spinal manipulation and rehabilitative exercise in addition to home exercise for senior citizens with low back pain?

Low back pain is a normal condition among senior citizens aged 65 and over. Between 23 and 58 % of all senior citizens suffer from low back pain, which often results in limited physical function and quality of life. Spinal manipulation has been shown to have similar effect as medical treatment, but maybe a combination of manipulation and exercise can improve the effect of the treatment.

To further explore, researchers from the US conducted a randomized clinical trial with three different treatment groups among senior citizens suffering from sub-acute or chronic low back pain: 1) home exercise; 2) supervised rehabilitative exercise combined with home exercise or 3) manipulation combined with home exercise. The trial was carried out over 12 weeks and the participants’ results were collected after 4, 12, 26 and 52 weeks. The primary outcome was the participants’ assessment of pain severity. Secondary outcomes included back disability, health status, medication use, satisfaction with care, and global improvement.

241 participants were randomised and 230 (95 %) contributed data throughout the study. The primary analysis of pain severity over the one-year showed small and statistically non-significant differences between treatment groups. In all three groups, pain was reduced by 30-40 % after treatment, with the biggest difference being between manipulation combined with home exercise compared to home exercise only. At the other time points, the differences between groups varied between 0 and 6 percentage points without one group standing out. One year later, the reduction of pain after treatment was diminished in all three groups. The secondary outcomes followed the same pattern, except for satisfaction with care, where the combination treatments scored better than home exercise alone.

Is it better to combine manipulation of the back or supervised rehabilitative exercise with home exercise? No, there is nothing in the outcome of the clinical studie that points to combined treatment being better than home exercise only regarding improving pain or disability either short term or long term for older adults with sub-acute or chronic back pain, but the combination treatment seems to increase treatment satisfaction among the patients – and that might influence their life quality in a positive way.

Schulz, C., Evans, R., Maiers, M. et al. Spinal manipulative therapy and exercise for older adults with chronic low back pain: a randomized clinical trial. Chiropr Man Therap 2019. https://doi.org/10.1186/s12998-019-0243-1


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