A critical review of the role of manual therapy in the treatment of individuals with low back pain

Review written by Dr Jarod Hall info

Key Points

  1. In general, clinical practice guideline (CPG) recommendations show consistent alignment for various interventions in patients with low back pain, but inconsistencies remain, particularly for manual therapy despite analyzing the same scientific literature.
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BACKGROUND & OBJECTIVE

Low back pain (LBP) is one of the most common musculoskeletal pathologies found worldwide and one of the main causes of disability (1). Despite escalating healthcare costs associated with a rise in spinal fusion surgeries, facet joint injections, opioid prescriptions, and increasingly advanced diagnostic imaging studies, the burden of LBP remains substantial (2-5). Considering the harms caused by the opioid epidemic and the limited efficacy of other pharmacological treatment options, current clinical practice guidelines (CPG) indicate that medications should be used as a second line intervention while the focus should be placed on nonpharmacological interventions.

While the primary first line nonpharmacological approach for patients with low back pain has been described as exercise, education, and advice for self-management, manual therapy (MT) may be valuable for these patients as well. Although there is no uniformly used definition of MT in research or clinical practice, it is usually defined as a passive or mechanical intervention manually applied to patients in the form of manipulation, mobilization, or massage. Even though CPGs broadly analyze the same data and present several consistent recommendations in patients with LBP, inconsistencies remain, particularly for MT.

This narrative review aimed to critically summarize the available evidence underlying the disparate recommendations of the LBP guidelines for MT.

Despite escalating healthcare costs associated with a rise in spinal fusion surgeries, facet joint injections, opioid prescriptions, and increasingly advanced diagnostic imaging studies, the burden of low back pain remains substantial.
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Clinicians administering manual therapy should engage in accurate evidence-based discussions regarding the mechanisms of action.

EVIDENCE FOR MANUAL THERAPY IN TREATING LOW BACK PAIN

Acute LBP: The United Kingdom evidence report on MT for musculoskeletal and non-musculoskeletal conditions analyzed 178 relevant studies and found inconclusive evidence regarding whether MT for LBP was more effective than other treatments, placebo, or no treatment. A Cochrane review

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