McKinney Chiropractor Best Practices

Research Commentary;

Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better Long-Term Outcome?

Mohammed K. Senna, MD, and Shereen A. Machaly, MD

Research reviewed by Dr. Travis Downs

Summarized Review Conclusions

This study helps us to learn a few things about the treatment of lower back pain. The chiropractic adjustment is not only effective with low back pain in the chronic phase of pain but also shown to be long-term benefit towards wellness.  This research clearly outlined that when a chronic patient gets out of the acute phase of pain they should begin a phase of maintenance to solidify their healing, this choice of maintenance will help them to achieve wellness. In the presence of chronic pain and inflammation the lifestyle habits you developed to create the problem are the habits you must change to eradicate the problem. The first item each patient wants to address is pain, the next items they need to address are their negative habits from eating, moving and daily stress. Human health is maintained or destroyed over a period of time with a repetition of choices; good and bad. Our ability to help a patient resolve these issues is often further than the pain treatment alone. The continuation of their maintenance care program along with better lifestyle choices is what will sustain the healing process and allow them to maintain a pain free life. The strongest conclusion of this research began in the last 10 months of the research where the group receiving adjustments once every 2 weeks, for the 10 months continued to show improvement and move towards wellness.  The group that did not receive adjustments and the group receiving fake adjustments returned to their pre-acute levels of pain and dysfunction.  This shows the need for patients moving towards sustained wellness must include a maintenance period of 10 months.

“Nonspecific LBP represents about 85% of LBP patients seen in primary care.4 About 10% will go on to develop chronic, disabling LBP.5 It is this group of LBP that uses the majority of health care and socioeconomic costs.6,7 “

  1. Carey TS, Garrett JM, Jackman AML. Beyond the good prognosis: examination of an inception cohort of patients with chronic low back pain. Spine (Phila Pa 1976) 2000;25:1:115–20.
  2. Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000;84:95–103.
  3. Kent PM, Keating JL. The epidemiology of low back pain in primary care. Chirop Osteop 2005;13:13.

“Despite the three groups of patients were similar at baseline evaluation (Tables 1 and 2), patients in the second and third groups experienced significantly lower pain and disability scores compared with the control group after the first phase of treatments, that is, after 1-month period. By the end of second phase of treatment (after 10-month period), patients with maintained SMT had significantly lower pain and disability scores compared with the patients of the non-maintained SMT group. “

Mohammed K. Senna, MD, and Shereen A. Machaly, MD

“By the end of the study, pain score yielded a reduction of 19.26 mm in the maintained SMT group whereas it is returned near to the pretreatment level in the group of patients who discontinued their therapy interventions (Table 6 and Figure 2). “

Mohammed K. Senna, MD, and Shereen A. Machaly, MD

“SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative. “

Mohammed K. Senna, MD, and Shereen A. Machaly, MD

Introduction to the Research

When we look at research for chiropractic care and low back pain, most of it will only deal with the acute or initial treatment to see when the spinal manipulation therapy (SMT) will relieve the pain in the patient. This Randomized Controlled Trial research takes it a step further and looks at the participants with chronic low back pain that have been experiencing the pain for longer than 6 months.  The study continues to examine these patients after they have resolved the acute pain to evaluate the benefits of a maintenance (stabilization) period of care against participants without any maintenance (stabilization) care.  The fact is LBP will effect 80% of the adult population at some point in their life.   For this reason, this RCT research provides us with information that will be of the highest benefit for the patient and practitioner.

Research Methodology

Sixty patients, with chronic, nonspecific LBP lasting at least 6 months, were randomized to receive either (1) 12 treatments of sham SMT over a 1-month period, (2) 12 treatments, consisting of SMT over a 1-month period, but no treatments for the subsequent 9 months, or (3) 12 treatments over a 1-month period, along with “maintenance spinal manipulation” every 2 weeks for the following 9 months. To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-, 4-, 7-, and 10-month intervals.

Research Findings

  • SMT is effective for the treatment of chronic nonspecific low back pain. To obtain long-term benefit, this study suggests maintenance adjustments after the initial intensive manipulative therapy.
  • Application of SMT yielded better results when com- pared with the sham manipulation.
  • We suggest that maintained SMTis beneficial to patients of chronic nonspecific LBP particularly those who gain improvement after initial intensive manipulation to maintain the improved posttreatment pain and disability levels

Research References

As always with these reviews, these are my takeaways from the article, and I encourage you to read the article in its entirety.  The references used in this article by the authors of this article are listed below.


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