What the Research Says
Published: 2009-07-17 21:46:37
Author: Malik Slosberg | Dynamic Chiropractic | July 15, 2009
Over the past 10 years, there have been many articles evaluating the effectiveness of exercise training and spinal manipulation as single interventions. In addition, several studies have assessed the benefits of exercise in combination with spinal manipulation. Various reviews of the literature and guidelines have summarized the results of research articles on the interaction between spinal manipulation and exercise. Although not all studies agree, the majority suggest that there appears to be a synergistic effect when both manipulation and exercise are used in combination.
From a purely logical perspective, it makes sense that spinal manipulation will add a substantial benefit to exercise. Manipulation by improving range of motion, overcoming abnormal restrictive barriers, increasing and normalizing mechanoreceptive input from articular and periarticular structures, and restoring normal motor programs may allow a joint to derive more benefit from exercise training while minimizing the risk of injury.
Spinal Manipulation and Stabilization Exercises
Morton published a preliminary prospective study comparing stabilization exercises (four weeks to contract transverse abdominis and improve co-contractions between multifidi and abdominal muscles) versus stabilization exercise and spinal manipulation (SM) (twice a week for four weeks).1 At three-month follow-up, the manipulation plus exercise group had 90.3 percent less disability based on the Roland-Morris Disability Index, 100 percent less pain (all subjects in the manipulation plus exercise group were pain-free, while 13 of 14 still had pain in the exercise-alone group), and 46.4 percent greater range of motion. The paper concluded that patients who received manipulation plus exercise improved more and faster than those who received stabilization exercises alone. Significant differences between groups were seen within the first week. In addition, manipulation also appeared to be cost-effective.
HVLA Manipulation, Mobilization and Exercise
Aure, et al., published a longitudinal study with a one-year follow-up in a group of 49 chronic low back pain patients, all of whom were on 100 percent sick leave for more than eight weeks but less than six months due to their low back problems.2The patients were randomized into two groups. Both groups received 16 visits over eight weeks to physical therapists who provided either 45 minutes of general and stabilizing exercises or 15 minutes of high-velocity, low-amplitude manipulation and mobilization and 30 minutes of general and stabilizing exercises. There were significant differences between groups at the end of eight weeks, which were sustained at both six-month and 12-month follow-up. The authors concluded that manual therapy plus exercise showed significantly greater improvements than exercise alone on all outcome measures both on short and long-term follow-up.
The U.K. Back, Exercise and Manipulation (BEAM) Trial
The U.K. BEAM trial was published in two papers.3,4Unlike previous studies, this was a very large scale (N=1,334) longitudinal study (12-month follow-up) comparing low back pain patients randomized into four treatment groups. All groups received "best care" general practice that included advice to stay active, a back care booklet and visits to primary care medical doctors.