Chiropractic Enhances Benefits of Exercise for Back Pain

Countless studies have demonstrated the benefits of exercise therapies for relieving musculoskeletal conditions like chronic back pain. Now recent research shows that spinal adjustments, commonly used by chiropractors, may actually enhance the benefits of exercise therapies for back pain.

Many patients with back pain are assigned active exercises to relieve back pain, but avoid performing these exercises due to fear of movement or re-injury. Since manual therapies have been shown to relieve back pain, researchers from Switzerland set out to see whether such treatments could "facilitate the practice of subsequent active exercises and improve outcomes in [chronic, non-specific, low-back pain]."

They studied 49 people with chronic back pain who were randomly assigned to receive either manual therapy followed immediately by active exercises or a sham treatment with immediate active exercises. Manual therapies consisted of treatments frequently employed by chiropractors including spinal adjustments and spinal mobilization. Active exercises included passive stretching, muscle and motor control exercises, mobility exercises, and strengthening. The patients received eight treatments and were evaluated after three and six months.

The addition of manual therapy was not found to significantly affect fear of movement or improve abdominal endurance in this study. However, immediately after treatment, patients receiving manual therapy plus exercise experienced better pain relief than the control group. The advantage seen in the treatment room continued at the three and six-month follow-up visits. The manual therapy patients had lower disability and a trend towards lower pain scores compared to the control group.

The findings suggest that a combined treatment of chiropractic and exercise could be better than active exercises alone for back pain. Although earlier studies investigated the combined effects of manual therapies and exercise, the authors of this study believe theirs is the first to incorporate a true placebo.

Researchers concluded that manual therapy followed by specific active exercises "reduces significantly functional disability and tends to induce a larger decrease in pain intensity."


Balthazard P, et al. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskeletal Disorders 2012; 13: 162. doi:10.1186/1471-2474-13-162.