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The Somatic Connection  |   May 2015
Manual Manipulation Is More Effective Than Mechanical-Assisted Manipulation in Managing Low Back Pain
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   May 2015
Manual Manipulation Is More Effective Than Mechanical-Assisted Manipulation in Managing Low Back Pain
The Journal of the American Osteopathic Association, May 2015, Vol. 115, 344. doi:10.7556/jaoa.2015.068
The Journal of the American Osteopathic Association, May 2015, Vol. 115, 344. doi:10.7556/jaoa.2015.068
Schneider M, Haas M, Glick R, Stevans J, Landsittel D. Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial. Spine (Phila Pa 1976). 2015;40(4):209-217. 
The global lifetime prevalence of low back pain (LBP) is reported to be as high as 84%.1 For acute low back pain, spinal manipulation is associated with short-term benefits.2 Previous research3 suggested that mechanical-assisted manipulation (MAM) is equivocal to manual thrust manipulation (MTM) in terms of effectiveness. 
Schneider et al conducted a randomized clinical trial that investigated the effects of MTM compared with MAM and usual medical care (UMC) on acute and subacute LBP. All participants (N=107; mean age, 41 years) had had a new LBP episode within the previous 3 months. Exclusion criteria included the following: (1) chronic LBP lasting more than 3 months; (2) “previous chiropractic, medical, or physical therapy treatment for the current LBP episode”; (3) radiculopathy; (4) contraindications to spinal manipulation; and (5) current prescription pain medication use. 
Participants were randomly assigned to 1 of 3 study groups: UMC, MTM, or MAM. Participants in the UMC group were seen by a physical medicine and rehabilitation physician, who prescribed over-the-counter analgesic and nonsteroidal anti-inflammatory medications and advised participants to stay active and to avoid prolonged bed rest. Participants in the MTM group received spinal manipulation by a licensed chiropractor, and MAM participants received spinal manipulation using the Activator IV Instrument by a certified chiropractor. Participants were treated over 4 weeks. Both the MTM and MAM groups attended 2 visits per week (8 visits total). The UMC group attended 3 office visits: 1 initial visit and 2 follow-up visits at weeks 2 and 4. 
Primary outcome measures included the Oswestry LBP Disability Index and a self-reported pain intensity scale (0, no pain; 10, unbearable pain). Outcomes were assessed at baseline, 4 weeks, 3 months, and 6 months. A significant decrease in both disability and pain at 4 weeks compared with baseline was noted in the MTM group compared with the MAM (disability score= -8.1, P=.009; pain score= -1.4, P=.002) and UMC (disability score= -6.5, P=.032; pain score= -1.7, P<.001) groups. No statistically significant differences were noted between MAM and UMC or for any comparison at 3 or 6 months. 
One major limitation of this study is that other outcome measures were not examined, particularly nonprescription medication use. Because all participants were allowed to use analgesics and nonsteroidal anti-inflammatory medications, it would be interesting to see if any differences between treatment groups existed or if any changes occurred in use over time. Another limitation of this study is the lack of a sham therapy or control group. However, the findings in this study are promising in that MTM can be considered part an effective treatment plan for patients with LBP. 
References
Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain [review]. Lancet. 2012; 379(9814): 4-10. [CrossRef] [PubMed]
Chou R, Qaseem A, Snow V, et al; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147(7): 478-491. [CrossRef] [PubMed]
Shearar KA, Colloca C, White HL. A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome. J Manipulative Physiol Ther. 2005; 28(7): 493-501. [CrossRef] [PubMed]