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The Somatic Connection  |   January 2015
Spinal Manipulation and Home Exercises Are Effective for Subacute and Chronic Back-Related Leg Pain
Article Information
The Somatic Connection   |   January 2015
Spinal Manipulation and Home Exercises Are Effective for Subacute and Chronic Back-Related Leg Pain
The Journal of the American Osteopathic Association, January 2015, Vol. 115, 55. doi:10.7556/jaoa.2015.013
The Journal of the American Osteopathic Association, January 2015, Vol. 115, 55. doi:10.7556/jaoa.2015.013
Web of Science® Times Cited: 13
Bronfort G, Hondras MA, Schulz CA, et al. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain. Ann Intern Med. 2014;161(6):381-391. doi:10.7326/M14-0006. 
Back-related leg pain (BRLP) is a common complaint of persons with low back pain (LBP). Patients with LBP-associated BRLP typically have a poorer prognosis and quality of life than those without BRLP. With the increasing costs of medical care and pharmaceuticals, spinal manipulative therapy (SMT) and self-management techniques are becoming more desirable, although there has been little evidence to support their benefit. The purpose of this study was to test the hypothesis that SMT and home exercise and advice (HEA) are superior to HEA alone for the treatment of patients with subacute and chronic BRLP. 
A total of 192 patients were enrolled in the study. Inclusion criteria included age 21 years or older; Quebec Task Force on Spinal Disorders category 2, 3, 4, or 6; pain severity of 3 or greater on a 10-point scale; current BRLP episode of 4 weeks or more; and a stable medication regimen. All patients were standardized for "age, BRLP duration, neurologic signs, distress, positive straight-leg raise, time spent driving a vehicle, and pain aggravation with coughing or sneezing" and then randomly assigned to receive HEA alone or HEA in conjunction with SMT for 12 weeks. 
The HEA group (n=96) attended four 1-hour sessions, during which they were educated on personalized ways "to manage existing pain, prevent pain recurrences, and facilitate engagement in daily activities." They also received take-home review materials. The instructors e-mailed or telephoned patients at 1, 4, and 9 weeks to assess adherence. 
The group that received SMT in addition to HEA (n=96) attended a maximum of 20 SMT visits lasting 10 to 20 minutes and 4 HEA sessions as described above. The SMT was applied by 1 of 11 experienced chiropractors and included manual techniques to the lumbar and sacroiliac joints on the basis of patient's symptoms and the chiropractor's findings on palpation. 
The primary outcome measure was patient-reported leg pain during the previous week, assessed using an 11-point scale. The primary outcome was modeled with mixed-effects regression over baseline and Bonferroni adjustment to control for 2 test groups with 2 different end points (12 and 52 weeks). When considering the primary outcome, the findings showed a statistically significant advantage of SMT plus HEA over HEA alone at 12 weeks (P=.008) but not at 52 weeks (P=.146). At 12 weeks, 37% of patients in this group had a 75% or greater reduction in leg pain, and 20% had a 100% reduction compared with 19% and 5%, respectively, in the HEA group. The study findings support the use of SMT and HEA for the short-term, conservative treatment of patients with subacute and chronic BRLP. (doi:10.7556/jaoa.2015.013) 
Kraig K. Wasik, OMS IV 
Western University of Health Sciences College of Osteopathic Medicine of the Pacific (WesternU/COMP)-Northwest, Lebanon, Oregon 
Michael A. Seffinger, DO 
WesternU/COMP, Pomona, California 
© 2015 American Osteopathic Association