Comparative Effectiveness of Exercise, Acupuncture, and Spinal Manipulation for Low Back Pain

Abstract

Structured exercise and SMT appear to offer equivalent benefits in the management of pain and function for patients with nonspecific chronic LBP. If no clinical benefit is appreciated after using one of these approaches for 8 weeks, then the treatment plan should be reevaluated and consideration should be given to modifying the treatment approach or using alternate forms of care. Strength of recommendation: Weak.There is insufficient evidence regarding the relative benefits of the acupuncture compared with either structured exercise or SMT in the treatment of chronic LBP.There is insufficient evidence to address differential effects of structured exercise, SMT, or acupuncture for specific subgroups of individuals with chronic LBP. There is insufficient evidence regarding the relative cost-effectiveness of structured exercise, SMT, or acupuncture in the treatment of chronic LBP.

The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews

“…Thus, this SR deviates and provides clinicians and researchers with new information compared with other recent high quality SRs 41,43,45 which are focused more on manipulation. A detailed summary of these updated findings, as well as the strength of their evidence and level of agreement with existing studies, are presented in Table 4.…”

“…The present SR updates previous reviews, and is the first to focus specifically on different MT approaches for different stages of LBP. New findings, as well as new evidence to inform findings from previous systematic reviews, [41][42][43][44][45] are presented.…”

Quality of Systematic Reviews on Specific Spinal Stabilization Exercise for Chronic Low Back Pain

“…Thirteen reviews 1,6,9,13,15,[20][21][22]38,39,[42][43][44] were eliminated after further evaluation. Reasons for exclusion included assessed outcomes that were not disability or pain in 1 review, 20 interventions that were not focused on specific stabilization exercises in 8 reviews, 9,15,21,38,39,[42][43][44] and the lack of an SR format in 1 review. 22 Additionally, 2 reviews were practice guidelines, 1,6 and 1 13 was a duplication of findings published in another review.…”

“…Twenty-one articles 1,6,8,9,[12][13][14][15][20][21][22]24,25,28,33,[38][39][40][42][43][44] were selected for further evaluation. Thirteen reviews 1,6,9,13,15,[20][21][22]38,39,[42][43][44] were eliminated after further evaluation. Reasons for exclusion included assessed outcomes that were not disability or pain in 1 review, 20 interventions that were not focused on specific stabilization exercises in 8 reviews, 9,15,21,38,39,[42][43][44] and the lack of an SR format in 1 review.…”

Impact of selected magnetic fields on the therapeutic effect in patients with lumbar discopathy: A prospective, randomized, single-blinded, and placebo-controlled clinical trial

“…[14][15][16][17] The methods used for therapeutic purposes include standard kinesiotherapeutic exercises, various massage and neuromobilization methods, proprioception training, and manual mobilization and manipulation techniques in individual therapy with the patient, as well as a wide range of physical methods, including magnetic therapy and magnetic stimulation. [18][19][20][21][22] Even though many various physical therapy methods are used on a daily basis to combat LBP, few of them are based on substantiated and reliable scientific grounds supported by reliable clinical research of high methodological quality. This also refers to the use of magnetic fields, which may often prove to be of little or no help, and are therefore completely pointless.…”