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Low back pain: spinal manipulation works for some patients but has no effect in others

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Low back pain can be relieved with spinal manipulation in some patients, according to a study published in the journal Spine. But the research also confirmed that the treatment does not work for everyone.

Spinal manipulation involves applying force to move joints as a way of treating pain.

Researchers at the University of Alberta set out to determine whether patients with low back pain who respond to the treatment differ biomechanically from non-responders, untreated controls or asymptomatic controls.

“Back pain, just like cancer, is a collection of different kinds of problems. We haven´t been very good at distinguishing who has which problem, so we throw a treatment at people and naively expect that treatment to fix everyone´s back pain,” said lead author Greg Kawchuk, an expert in spine function and professor in the Faculty of Rehabilitation Medicine.

“This study shows that, just like some people respond differently to a specific medication, there are different groups of people who respond differently to spinal manipulation.”

The non-randomized control study found that people who responded to spinal manipulative therapy reported less pain right away and showed improvement in back muscle thickness, disc diffusion and spinal stiffness. Those changes were great enough to exceed or equal the measures in the control groups and stayed that way for the week of treatment, the University of Alberta reported.

At the same time, participants with back pain who reported no improvement showed no physical changes.

Kawchuk said that the results help explain why there has been so much conflicting data about the merits of this technique.

“Clearly there are some people with a specific type of back pain who are responding to this treatment and there are some people with another type of back pain who do not. But if you don´t know that and you mix those two groups together, you get an artificial average that doesn´t mean anything,” the professor explained.

The researchers are still working on how to distinguish who is likely to respond before spinal manipulation is given. But their work has already shown that it can be used to identify an effective treatment course.

“Spinal manipulation acts so rapidly in responders that it could be used as a screening tool to help get the right treatment to the right patient at the right time,” Kawchuk suggested.

Next, the research team will investigate the long-term effects of spinal manipulation in patients with low back pain.