Manipulation or Exercise for Low Back Pain?

Low back pain affects 80% of the population at some point in their life, costing billions of dollars in lost productivity and health care.  There are many different treatment options available as individual response to care is unique.  A 2011 clinical trial reported in The Spine Journal compared two proven conservative care therapies, spinal manipulation and exercise, in chronic low back pain.

 

300 participants were divided into three groups: supervised exercise; spinal manipulation and home exercise with advice for a 12 week program.  There were equally improved outcomes in all groups, with a 40-50% reduction in pain and disability.  As would be expected, endurance and strength improved in the exercise groups more than the manipulation group.   

Results parallel the 2004 UK BEAM study comparing spinal manipulation and exercise, which found that manipulation and exercise were equally successful in treating low back pain, but that spinal manipulation combined with exercise did better than manipulation or exercise alone.  This supports what chiropractors have been doing for years, keeping the spines of patients functional through manipulation and providing exercise advice and encouragement to strengthen the core to stabilize the spine. 

Managing Pain with Acupuncture

Inflammation is the first phase of healing, but the pain associated with this inflammation may predispose some patients to chronic pain and disability.  If the initial pain experience is severe and continues, central pain hypersensitivity may develop.  Early intervention and prevention remain the best treatment, with rapid pain relief being the key. 

Acupuncture reduces pain via two different mechanisms.  It decreases the stimulation of nerve signals that lead to pain and it also reduces the expression of inflammatory chemicals that stimulate nerve endings that cause pain. 

Acupuncture may provide an analgesic effect by encouraging release of opiate based chemicals in the body and release of serotonin in the central nervous system.  It may also inhibit stimulation of the sympathetic nervous system to regulate inflammation and pain.  Acupuncture also seems to suppress Cox-2 in the spinal cord; Cox inhibitors are commonly used with some NSAIDs. 

If the patient’s pain is desensitized and there is increase tolerance to painful activities and therapy, the patient will hopefully avoid chronic pain syndrome and recover function faster to get their life back!