Researchers around the world are studying ways to treat chronic low back pain (LBP). Physiotherapy is often prescribed. The patient may be treated with manual therapy, which includes joint manipulation or the more gentle joint mobilization. Sometimes therapists combine manual therapy with exercises, heat, or electrical therapy. But what works best?

In this study the results of spinal stabilization exercises are compared to manual therapy. A control group with minimal treatment was also included. Stabilization exercises consist of movements requiring contraction of the abdominal and trunk muscles at the same time. The goal is to hold the spine steady (or stable) during movement.

Level of back pain, function, and use of pain relievers were used to measure the success of these three treatment methods. Patients were also asked about quality of life (QOL) as an outcome measure.

All patients had less pain in the first three months after treatment. Pain relief was greatest in the manual therapy group. Long-term results showed pain was still less six to 12 months later for stabilization exercises and manual therapy, but not for the education group. The spinal stabilization group had the best reduction in disability at each follow up visit. The same was true for improved quality of life and use of pain relievers.

Overall the results of this study favor the use of spinal stabilization exercises over manual therapy or education for chronic LBP. Manual therapy and spinal stabilization significantly reduced pain. The authors suggest manual therapy should not be used alone to treat chronic LBP. By itself, manual therapy doesn't reduce disability or improve QOL.

Lucy Jane Goldby, PhD, et al. A Randomized Controlled Trial Investigating the Efficiency of Musculoskeletal Physiotherapy on Chronic Low Back Disorder. In Spine. May 1, 2006. Vol. 31. No. 10. Pp. 1083-1093.