Chronic Low Back Pain: Exercise? Manipulate? Needle? 2012 Update!

Reference:Trigkilidas D. Acupuncture therapy for chronic lower back pain: a systematic review. Ann R Coll Surg Engl. 2010 Oct;92(7):595-8. Epub 2010 Jun 7.
Standaert CJ, et al Comparative effectiveness of exercise, acupuncture, and spinal manipulation for low back pain. Spine (Phila Pa 1976). 2011 Oct 1;36
Furlan AD, et al Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev. 2005 Jan 25;(1)

Here are three (3) excellent questions asked and answered by this latest systematic review published in the journal Spine with respect to the treatment of Chronic low back pain (LBP).

Question #1: Is a structured exercise program more effective than spinal manipulative therapy?

Answer: Based on low evidence, they are of similar benefits with the most benefit seen after 8 weeks. If no benefit is seen by 8 weeks, further treatment is not justified and alternative treatment approaches is suggested.

Question #2: Are structured exercises or manipulation more effective than acupuncture?

Answer: Not enough evidence to date to comment

Question #3: Do certain subgroups respond more favourably to specific treatments?

Answer: Not enough evidence to date to comment, but a 2010 systematic review showed that acupuncture was superior to usual care in treating chronic LBP, when patients had a positive expectations about acupuncture (Trigkilidas 2010).

Basically if a patient admits to “not liking needles” or “believing in needles” the less likely it will help them!

The Cochrane Database suggests that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain. (Furlan 2005)

How can we apply this evidence into practice?

In summary, if a patient with chronic LBP has received 2 months of exercises with little benefit, they should try spinal manipulation and acupuncture, if they’ve received 2 months of manipulation with little benefit, they should try a structured exercise program and acupuncture.

Personal Comment:Of all the pain-relieving modalities used by PTs, the only one I truly endorse based on the evidence, is Acupuncture / Dry Needling.

Posted on: October 15, 2012

Categories: Lumbar Spine , Modalities / Meds / Supplements

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