A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain

ObjectivesTo assess the short- and long-term effectiveness of spinal manipulation therapy, and to identify the effect of manipulation on lumbar muscle endurance in patients with chronic low back pain (LBP).DesignA randomised controlled trial comparing manipulation and exercise treatment with ultrasound and exercise treatment.SettingAn outpatient physiotherapy department.ParticipantsOne hundred and twenty patients with chronic LBP were allocated at random into the manipulation/exercise group or the ultrasound/exercise group.InterventionsBoth groups were given a programme of exercises. In addition, one group received spinal manipulation therapy and the other group received therapeutic ultrasound.Main outcome measuresPain intensity, functional disability, lumbar movements and muscle endurance were measured shortly before treatment, at the end of the treatment programme and 6 months after randomisation using surface electromyography.ResultsFollowing treatment, the manipulation/exercise group showed a statistically significant improvement (P = 0.001) in pain intensity [mean 16.4 mm, 95% confidence interval (CI) 6.1–26.8], functional disability (mean 8%, 95% CI 2–13) and spinal mobility (flexion: mean 9.4 mm, 95% CI 5.5–13.4; extension: mean 3.4 mm, 95% CI 1.0–5.8). There was no significant difference (P = 0.068) between the two groups in the median frequency of surface electromyography (multifidus: mean 6.8 Hz, 95% CI 1.24–14.91; iliocostalis: mean 2.4 Hz, 95% CI 2.5–7.1), although a significant difference (P = 0.013) was found in the median frequency slope of surface electromyography in favour of spinal manipulation for multifidus alone (mean 0.3, 95% CI 0.1–0.5). A significant difference was also found between the two groups in favour of the manipulation/exercise group at 6-month follow-up.ConclusionsAlthough improvements were recorded in both groups, patients receiving manipulation/exercise showed a greater improvement compared with those receiving ultrasound/exercise at both the end of the treatment period and at 6-month follow-up.