A combination of self-care education, aerobic and strength-training exercise, and spinal manipulation therapy may provide greater pain relief and improved treatment satisfaction compared with exercise only in adolescents with low back pain, according to a study published in Pain.

Investigators randomly assigned 185 individuals with low back pain age 12 to 18 years to follow an exercise therapy alone (n=92) or in combination with spinal manipulation therapy (n=93).

Exercise therapy consisted of self-care education dealing with pain management, the importance of physical activity, and spinal posture awareness, as well as supervised and at-home aerobic and stretching/strength training exercise sessions.

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Spinal manipulation therapy focused on the lumbar vertebral or sacroiliac joints during 8 to 16 chiropractic sessions lasting 10 to 20 minutes up to 2 times per week. Pain levels (primary outcome), disability, quality of life, medication use, and patient- and caregiver-rated improvement and satisfaction (secondary outcomes) were assessed at 4, 8, 12, 26, and 52 weeks.

Over the 52-week study period, patients assigned to the combination therapy group vs exercise only reported greater reductions in low back pain severity (P =.007). Group differences for low back pain severity were significant starting at week 26 (P <.001) and week 52 (P =.009).

At the 26-week follow-up, patients in the combination therapy vs education/exercise alone group reported greater overall improvement (group difference, -0.41; 95% CI, -0.77 to -0.06; P =.02) and greater reductions in disability (group difference, 0.84; 95% CI, 0.03-1.65; P =.04).

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In addition, patients randomized to spinal manipulation therapy plus exercise reported higher levels of satisfaction at each follow-up assessment compared with those in the exercise-only group (P =.02 at weeks 12 and 52; P =.003 at week 26).

The inability to blind participants to group allocation and the relatively small sample size represent 2 limitations of this study.

“[This study] has important implications for providers who use spinal manipulation and exercise in practice such as chiropractors, physical therapists and osteopaths, and other providers who refer to them,” concluded the study authors.

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Evans R, Haas M, Schulz C, Leininger B, Hanson L, Bronfort G. Spinal manipulation and exercise for low back pain in adolescents: a randomized trial [published online March 27, 2018]. Pain. doi: 10.1097/j.pain.0000000000001211