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The Effectiveness of Back Pain Exercise & Manipulation in Primary Care

Most doctors and therapists who treat back pain understand that low back pain can be a challenge in clinical practice. Because it is such a prevalent, expensive, and crippling condition, very little information is available about effective treatments.

Low back pain can be treated with two methods: exercise and spinal manipulation. However, little is known about the benefits these treatments can provide in addition to regular care (which may include advice to remain active and possibly oral pain relief or anti-inflammatory medication). 

This study was designed to determine whether spinal manipulation, exercise, or a combination of both can improve "best care" in the healthcare system (NHS) or private practices. You can also locate the Gilbert primary care doctors and physicians online at

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The options were offered who visited their general practitioners about low back pain.

1. General practice care – According to the national guidelines for acute back pain, this is "best care".

2. Exercise – A "back to Fitness" program that includes an initial assessment and group exercise classes with a physiotherapist. This will consist of eight 60-minute classes spread over two months.

3. Spinal manipulation – 8 treatments in 12 weeks by qualified practitioners (chiropractic/physiotherapy, osteopathy) in either an NHS facility or private practice

These results should be viewed in the context of two things. The first is that the number of sessions and treatments may not be representative of clinical practice. Active care and preventive advice given to patients is not mentioned, although this may be of additional benefit. This is because most of us do it in real-world practice settings.

Eight months could have passed between the last treatment and the last measurement. This leaves plenty of time for other factors to play. All of these benefits, small or moderate, must be considered in light of cost-effectiveness. This is discussed in the second part of the project.

Conclusions and Practical Application

Further evidence has been provided by this study that spinal manipulation and exercise can be combined to treat low back pain. While studies may only allow for certain interventions and techniques, in practice, a doctor or therapist might choose to use multiple techniques or modalities to tailor therapy plans.