Spinal Manipulation for Chronic Back-Related Leg Pain: Short-Term Relief Only

Summary and Comment |
October 9, 2014

Spinal Manipulation for Chronic Back-Related Leg Pain: Short-Term Relief Only

  1. Jamaluddin Moloo, MD, MPH

After 1 year, leg pain was no better after chiropractic care than after exercise alone.

  1. Jamaluddin Moloo, MD, MPH

Treatment options are limited for patients with back-related leg pain. Researchers in Minnesota and Iowa randomized 192 adults (mean age, 57) who had radiating pain from the lumbar spine into a lower extremity (duration, ≥4 weeks) to 12 weeks of either home exercise and advice alone, or exercise and advice plus spinal manipulative therapy. Spinal-manipulation patients received ≤20 sessions with chiropractors who delivered high-velocity, low-amplitude thrust procedures or low-velocity, variable-amplitude mobilization maneuvers to the lumbar vertebral or sacroiliac joints, plus adjunctive therapies (e.g., soft-tissue stretching) as needed. Patients in both groups received four 1-hour home exercise and advice visits, designed to help them manage pain and improve mobility.

At baseline, mean scores on the primary outcome — patient-rated leg pain during the past week on a scale of 0 to 10 — were about 6 in both groups. At 12 weeks, mean leg-pain scores were 2.9 in the spinal-manipulation group and 3.9 in the exercise-alone group (a significant difference); at 52 weeks, the difference between groups was no longer significant. Similarly, subjectively measured secondary outcomes (e.g., lower back pain, disability) favored spinal manipulative therapy at 12 weeks but not at 52 weeks.

Comment

At 12 weeks, patients who were randomized to spinal manipulative therapy showed greater improvements than did controls. However, the spinal-manipulation group was seen by clinicians far more frequently and received additional, adjunctive therapies. Still, adverse outcomes did not differ between groups; so, for patients inclined to undergo lumbar spinal manipulative therapy, we probably have no reason to discourage them.

Editor Disclosures at Time of Publication

  • Disclosures for Jamaluddin Moloo, MD, MPH at time of publication Grant / Research support Colorado Health Foundation

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