exercise compared to general exercises or manual therapy for the management of
low back pain: A systematic review and meta-analysis
MG, Lopes JM, Conceição CS, Araujo A, Brasileiro A, Sousa C, Carvalho VO, &
Archanjo FL. Physical Therapy in Sport. 2016; Epub ahead of print Accepted
August 9, 2016. doi: 10.1016/j.ptsp.2016.08.004
general exercises for people with chronic non-specific low back pain and
possibly as effective as manual therapy.
recommended for people with chronic non-specific low back pain. A common type of exercise is stabilization exercises,
which try to enable a person to better control and coordinate their spine and
pelvis. Unfortunately, there is conflicting research as to whether it is
successful in reducing pain and disability.
The authors of this systematic review aimed to compare the effectiveness
of stabilization exercises to general exercises or manual therapy in people
with chronic non-specific low back pain. The authors conducted a systematic review and meta-analysis of
randomized clinical trials among people without leg pain and with low back
symptoms for > 3 months. They evaluated the quality and outcomes of 11 trials,
which had 413 participants with stabilization exercises, 297 with general
exercises, and 185 with manual therapy.
The quality of the articles was relatively low, with scores ranging from
5 to 8 out of a possible score of 10. The
stabilization exercise programs ranged from 4 to 12 weeks with sessions 20 to
60 minutes per session that occurred 1 to 3 times/week. Overall, the authors
found that participants who completed stabilization exercises had greater pain
and disability improvements in comparison to general exercises. However, there were no differences in
function reported. The authors also
reported no significant differences in pain or disability when comparing
stabilization exercises to manual therapy.
reinforce that stabilization exercises or manual therapy may be a better choice
for chronic non-specific low back pain than general exercises for improving
outcomes. The difficulty with this is
that most rehabilitation programs are varied and make it difficult to
replicate. This is a similar issue with
manual therapy. Programs and treatment
times were wide-ranging and this could result in diverse results. It would be interesting to see if there is a
relationship between outcomes and rehabilitation program frequency or
duration. Manual therapy is also a very
broad term, and it would be interesting to see if specific techniques such as
joint mobilizations or massage techniques were more successful than
others. Manual therapy and stabilization
exercises resulted in similar outcomes.
However, it would be interesting to see if a combination of the two
approaches would be superior to just one of them. Ultimately, clinicians should consider stabilization
exercises or manual therapy for patients with chronic non-specific low back
for Discussion: What exercises do you
think are successful in treating low back pain?
What manual therapy techniques have you found to help in low back pain
by: Nicole Cattano
by: Jeffrey Driban
Neto, M., Lopes, J., Conceição, C., Araujo, A., Brasileiro, A., Sousa, C., Carvalho, V., & Arcanjo, F. (2016). Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis Physical Therapy in Sport DOI: 10.1016/j.ptsp.2016.08.004