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Spinal Manipulation Isn't for Every Back Pain Patient

Most patients with low back pain (LBP) get better with spinal manipulation. But some don't, and physical therapists are wondering why not. In this study, six factors were found to make a difference. Patients who don't get better with spinal manipulation have symptoms longer, back pain with buttock or leg pain, and normal lumbar spine motion. Hip motion and the results of a special test for the sacroiliac joint are also important.

Therapists used manipulation on the lumbar spine of 71 patients with LBP. The goal was to study patients who didn't get better with this treatment. If therapists can identify why these patients didn't improve, then future patients with similar symptoms can be treated with a better method.

Each patient received two treatments of spinal manipulation. Improvement was based on several measures. First, the patients reported they were at least 50 percent better. Spine and hip range of motion were also measured. Patients filled out a survey to assess function. Again, 50 percent or more improvement on these tests was needed to say the treatment was a success.

About two-thirds of the patients improved with manipulation. The rest didn't get better. The results of this study helped therapists find patients who should not be treated with manipulation. A longer duration of symptoms and pain down the buttock and leg signal that a poor result is likely with manipulation.

The authors say this is a first-step study. A second study is needed to repeat these findings. Long-term results of manipulation must also be studied. These steps are needed before clinical practice guidelines for the use of spinal manipulation can be published.

References: Julie M. Fritz, PT, PhD, ATC, et al. Factors Related to the Inability of Individuals with Low Back Pain to Improve with a Spinal Manipulation. In Physical Therapy. February 2004. Vol. 84. No. 2. Pp. 173-190.

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