Review of “Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better Long-Term Outcome? SPINE Volume 36, Number 18, pp 1427–1437 2011”

Chronic nonspecific LBP is a condition which affects over 80% of the population. The current standard of care is medication and rest. Yet, spinal manipulative therapy significantly decreases both pain and disability scores in the short term, and may help in the prevention of future episodes.

LBP is divided into three main categories: specific spinal pathology, nerve root pain/radicular pain and non- specific LBP. “Nonspecific” chronic LBP is the LBP that is not attributable to a recognizable, known specific pathology. Nonspecific LBP represents about 85% of LBP patients seen in primary care and 10% of these patients will go on to develop chronic, disabling LBP.

“The postulated modes of action of SMT include disruption of articular adhesions, improvement of trunk mobility, relaxation of hypertonic muscle by sudden stretching, release of entrapped synovial folds or plica, attenuation of alpha motor neuron activity, enhancement of proprioceptive behavior, and release of beta endorphins.”

The sixty patients, with chronic, nonspecific LBP lasting at least 6 months, were randomized to receive either12 treatments of sham SMT over a 1-month period, or 12 treatments, consisting of SMT over a 1-month period, but no treatments for the subsequent 9 months, or 12 treatments over a 1-month period, along with “maintenance spinal manipulation” every 2 weeks for the following 9 months. Pain and disability scores, generic health status, and patient satisfaction where measured prior to intervention and at 1, 4, 7, and 10-month intervals.

The group receiving 12 treatments over a 1-month period, along with “maintenance spinal manipulation” every 2 weeks for the following 9 months had the most improvement in pain and disability scores at the 10-month evaluation more than the non-maintained SMT group.

SMT is effective for the treatment of chronic nonspecific LBP. It is the most effective for long-term benefit with maintenance of SM after the initial intensive manipulative time frame.

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Originally published on Medium