Twelve weeks of spinal manipulative therapy (SMT) combined with exercise therapy (ET) is more effective than ET alone over a one-year period for adolescents with chronic low back pain (LBP), according to a study published in the July issue of Pain

Roni Evans, Ph.D., from the University of Minnesota in Minneapolis, and colleagues compared 12 weeks of SMT combined with ET to ET alone among 185 adolescents aged 12 to 18 years with chronic LBP. LBP severity was assessed at 12, 26, and 52 weeks; 179 adolescents provided data at 12 weeks and 174 at 26 and 52 weeks.

The researchers observed a larger reduction in LBP severity over the course of one year with adding SMT to ET (P = 0.007). At the end of treatment, the group difference in LBP severity was small (mean difference, 0.5; P = 0.08), but increased at weeks 26 (mean difference, 1.1; P = 0.001) and 52 (mean difference, 0.8; P = 0.009).

SMT with ET performed better than ET alone for disability and improvement (P = 0.04 and 0.02, respectively) at 26 weeks. At all time points, the SMT with ET group reported significantly greater satisfaction with care (P ≥ 0.02). No serious treatment-related adverse events were reported.


The primary outcome was the self-reported typical level of LBP severity over the past week measured with the 11-box numerical rating scale (0 = no pain, 10 = worst pain possible). The 11-box numerical rating scale performs similarly to the visual analog scale in adult and pediatric populations.

Secondary measures included patient-rated disability, quality of life, improvement, a frequency of medication use for LBP (d/wk), and patient satisfaction with care (7-point scale, 1 = completely satisfied, could not be better, 7 = completely dissatisfied, could not be worse).  Health care utilization and home exercise compliance were also ascertained.

"For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a one-year period, with the largest differences occurring at six months," the authors write. "These findings warrant replication and evaluation of cost-effectiveness."