Low back pain is the number one cause of disability worldwide!

We now have a better understanding that persistent low back is a multifaceted disorder associated with disability, loss of productivity at work and reduced mental health status. In fact, low back pain is the number one cause of disability globally! Health care professionals use a variety of modalities and therapies to help patients manage low back pain. In this post, I will write to you about the benefits of joint mobilizations and manipulations in relation to back pain and function.

What interventions do clinicians and research guidelines recommend for back pain?

Clinical practice guidelines for low back pain recommend reassurance for favorable prognosis, use of exercise therapy, avoiding bedrest, return to safe movement and normal activities and use of over the counter medications. Preference is given to movement over rest. However, because of debilitating pain and/or stiffness, many patients with back pain are afraid to move or get back to their normal day-to-day function. This is where mobilizations and manipulations can be helpful – to improve the quality of joint movements, reduce fear of movement and decrease pain.

What are Joint Mobilizations and Manipulations?

Manipulation and mobilizations are highly skilled hands on therapy techniques. These techniques aim to increase mobility in joints and relieve pain. During mobilization, the therapist slowly moves the joint within its normal range of motion. During manipulation, the therapist uses short, high velocity, low amplitude movements to push the joint beyond its normal range of movement.  Both directly aim to reduce stiffness in joints.

What is the state of evidence?

Evidence for the effectiveness of spinal manipulation or mobilizations used for back pain is mixed. However, some moderate - high quality systematic reviews and meta-analyses have found moderate evidence for the use of these therapies. For example, a systematic review by Bronfort G. and colleagues found moderate quality evidence that spinal mobilizations (grade 3 and above) and manipulations help manage low back pain better than a placebo.

Another high quality and recent systematic review by Coulter et al found moderate evidence that mobilizations and manipulation significantly reduce back pain and disability. The details of these studies can be found at the bottom of this post in the reference section.

Please note, many diseases and disorders can lead to low back pain. Mobilizations and/or manipulation are not appropriate treatments for all back-pain disorders. Your physiotherapist will perform a thorough assessment and determine which therapy or modality is safe and appropriate for your condition.

Take home messages

Joint mobilization and manipulations have an important place in the management of low back pain. These techniques are safe and used to increase mobility, reduce pain and disability. Do not take back pain lying down, seek help, use resources around you to improve your back health and function!

References

Bronfort, G., Haas, M., Evans, R. L., & Bouter, L. M. (2004). Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. The spine journal, 4(3), 335-356.

Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Booth, M. S., & Herman, P. M. (2018). Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. The Spine Journal, 18(5), 866-879.

Oliveira, C. B., Maher, C. G., Pinto, R. Z., Traeger, A. C., Lin, C. W. C., Chenot, J. F., ... & Koes, B. W. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal, 27(11), 2791-2803.