Skip to main content

Chronic low back pain is one of the leading causes of disability and reason for consultation among adults 45 years and above. Diagnosing the cause of chronic low back pain is time-consuming and often frustrating. Despite modern advances in medical technology, it remains to be a severe condition to diagnose adequately. 

What are the current recommendations?

Controlling chronic low back pain requires a multidisciplinary approach. It involves drug therapy, physical therapy, manipulation therapy, psychiatric counselling, and surgery. 

Managing low back pain consists of different, interconnected ways. The initial treatment is the use of non-steroidal anti-inflammatory drugs or weak opioids. Patients, however, noted side effects such as severe drug allergies, drug addiction, the formation of stomach ulcers, etc.

Behavioural therapy and psychiatric counselling is the most recommended treatment for chronic low back pain. It is notably due to stress, depression, anxiety, and other behavioural problems being its underlying cause. Though in some countries, social stigma and cultural aversion to mental health therapy hinder some patients from seeking this form of treatment.

Surgery is the least recommended because it is difficult to pinpoint the cause of chronic low back pain from a single, anatomical source. And aside from being expensive and stressful to the body, improvement of low back pain after surgical recovery is rarely reported by patients. 

Mobilization and manipulation therapy shows to be a promising, non-surgical, and non-pharmacologic (meaning no drugs involved) form of treatment for low back pain. 

You may ask why? Well, it is affordable, readily available, and you can even do them at home! 

The question is: is it
safe, effective, and comparable to the other forms of treatment as mentioned above?

A study that showed a great result

In the study entitled “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis,” the authors reviewed 7,360 published journals from January 2000 to March 2017, containing research about low back pain. 

After careful review of these journals, there were a total of 64 randomized clinical trials (RCTs) included. These patients are complaining of chronic, non-specific low back pain. Their symptom has a duration of at least three months. The patients’ average age was 42 years (range of 29 to 59 years old). All of them had followed up six months later after spinal manipulation.

For a little background, a randomized clinical trial (RCT) is a form of research. The researchers would compare the result of the treatment of interest against a placebo or other known and established procedures. In our case, the treatment of interest was manipulation and mobilization therapies.

The purpose of the authors in analyzing these studies is to know the efficacy, effectiveness, and safety of various mobilization and manipulation therapies for the treatment of chronic low back pain. 

What are the findings?

Some of the RCTs compared to placebo or other forms of treatment involved the following: 

  • 1. unimodal (one mode of therapy)
    • manipulation (thrust) like physical therapy or chiropractic therapy alone


  • 2. mobilization (non-thrust)
    • stretches
    • exercise
    • pilates
    • yoga
    • ultrasound
    • education, or
    • advice alone


  • 3. multimodal therapy 
    • combination of manipulation (thrust), and
    • mobilization (non-thrust) 
      • exercise
      • pilates
      • massage
      • physical therapy
      • chiropractic therapy

These methods lasted for 3 minutes for 16 sessions of 45 minutes each over eight weeks. 

The outcomes of the studies were measured using validated questionnaires. The questionnaires measured pain reduction, disability reduction, and increasing quality of life. These measurements were indicators of the effectiveness of the treatment. 

The result of their analysis showed that manipulation interventions could decrease pain intensity. Along with this, it may also reduce disability. Mobilization interventions alone do not have strong evidence of overall improvement.

On safety, manipulation and mobilization therapies are safe for managing chronic back pain. There were no adverse effects seen in the duration of the treatment.


Manipulation and mobilization therapies are synergistic. It means that they function twice as better when combined. 

When used separately, manipulation (i.e. physical therapy) has a much better profile in reducing pain and disability. It is better than doing mobilization therapy alone.

It is a cost-effective form of treatment in combination with other known therapies.

However, some questions remain after this study. What would be the effective treatment duration for manipulation and mobilization therapy? What are the dose requirements? What kind of practitioners should be involved? And lastly, who are the patients that would benefit the most from further studies?