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Chiropractic care, the most commonly used alternative therapy for back problems, is as effective as medical care alone for reducing disability and pain in patients with low back pain. Adding physical therapy to medical care may be marginally more effective than medical care alone for reducing disability, but the benefit is small, according to Hal Morgenstern, Ph.D., and his colleagues from the University of California, Los Angeles, and the Southern California University of Health Sciences. Their research was supported in part by the Agency for Healthcare Research and Quality (HS07755).
The researchers randomly assigned 681 low back pain patients who visited a large managed care facility from late 1995 through late 1998 to four treatment groups: medical care with and without physical therapy and chiropractic care with and without physical modalities (heat or cold therapy, ultrasound, and electrical muscle stimulation or EMS). Medical care included proper back care instructions; strengthening and flexibility exercises; prescriptions for pain medicine, muscle relaxants, and antiinflammatory agents; and recommendations about bed rest, weight loss, and physical activities. Chiropractic care included spinal manipulation or another spinal-adjusting technique and instruction in proper back care. Physical therapy could consist of heat or cold therapy, ultrasound, EMS, soft-tissue and joint mobilization, traction, supervised therapeutic exercise, and strengthening and flexibility exercises.
Based on questionnaire responses at 2 weeks, 6 weeks, and 6 months, most patients in all treatment groups had 2-point or greater reductions (on a 0 to 10 point scale) in their most severe pain by 6 months, with the greatest relief occurring in the first 2 weeks. All groups had more than a 3-point reduction (on a 0 to 24 point scale) in disability by 6 months. Patients in the medical and chiropractic care-only groups had similar mean changes in low back pain intensity and disability during each followup evaluation.
More details are in "A randomized trial of medical care with and without medical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study," by Eric L. Hurwitz, D.C., Ph.D., Dr. Morgenstern, Philip Harber, M.D., M.P.H., and others, in the October 15, 2002, Spine 27(20), pp. 2193-2204.
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