What do you think would happen if you had back pain? Would you get faster pain relief with manipulative treatment, exercises, and a doctor visit? Or would you do better if you just had an hour with the doctor? During this hour, you would get an exam, encouragement, and some instructions about posture, lifting, and stretching.

This was the focus of a study in Finland. The researchers made a guess that manipulative therapy with exercises along with a doctor visit would give better pain relief than just the doctor visit alone. What did they find?

The manipulative treatment and exercise group had a better outcome after five months. The results were equally good after 12 months. People getting manipulative therapy also used muscle exercises to stabilize the pelvis and low back. After the first doctor visit, they met with a physiotherapist four times over four weeks.

The group receiving manipulative therapy reported more pain relief and less disability compared to the group who saw a doctor once. Patients in the first group were given individual instructions, including advice about lifting. The also were given exercises to increase back motion and muscle flexibility. The instructions were repeated at the five-month check-up.

Health care costs were also measured and compared for each group. There weren't any differences in costs between these two groups. The authors conclude that a short, manipulative treatment program that includes exercise may work best patients with low back pain. Patients got fast pain relief, which may translate into fewer missed days at work or school.

Leena Niemistö, MD, et al. A Randomized Trial of Combined Manipulation, Stabilizing Exercises, and Physician Consultation Compared to Physician Consultation Alone for Chronic Low Back Pain. In Spine. October 1, 2003. Vol. 28. No. 19. Pp. 2185-2191.