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The Case for Manual Therapy to Treat Low Back Pain

Low back pain (LBP) is one of the most common medical complaints among adults of all ages, and it is frequently non-specific in nature, meaning the underlying cause is often unknown. LBP can range from mild to debilitating, and while acute (sudden onset) LBP is often resolved over the course of six weeks or less, chronic (ongoing) LBP can persist for months or even years.

It is often difficult to identify a structural cause of non-specific LBP, even when using imaging techniques like MRI, Xray or ultrasonography. Yet lack of evidence does not mean that pain does not exist, nor does it mean there is no underlying cause. In fact, there exists a wide range of potential causes of LBP, including:

  • Poor posture
  • Inefficient lifting techniques
  • Deficient movement mechanics
  • Long hours of sitting
  • Sedentary lifestyle
  • Weak core muscles
  • Overweight and obesity
  • Trauma
  • Repetitive overuse

Getting to the source of LBP poses a challenge for health care providers. While traditional medical treatment often centers on pain management using NSAIDs, opiates, and muscle relaxants to reduce pain and inflammation and relieve pressure on nerves, such treatment rarely resolves the underlying issues that are the true source of LBP.

Spinal Manipulative Therapy for LBP

A widely used but sometimes controversial treatment for LBP is spinal manipulative therapy (SMT), a course of treatments that includes both high-velocity manipulative techniques and low-velocity mobilization techniques. Because pain often stems from disturbance of the neural bodies that descend from the spinal column, SMT seeks to reduce neural pressure and thus alleviate pain.

A 2017 review of 26 randomized controlled trials by Paige et al. published in the Journal of the American Medical Association sought to discover whether SMT was effective in treating LBP:

  • The review involved 1711 individuals who were treated with SMT for acute low back pain lasting for up to 6 weeks.
  • Moderate decreases in pain and increases in function were found within six weeks of SMT intervention.
  • The decrease in pain was roughly equivalent to pain reduction associated with use of NSAIDs.
  • Improvement in function was variable, with reported improvement of one to 2.5 points on a scale of 24.
  • Lack of detail made it difficult to determine if any one SMT intervention was more strongly associated with improvement than others.

Chiropractors and physical therapists often take a multimodal approach to LBP treatment, incorporating heat and ice, SMT, stretching and strengthening exercises, gait retraining, postural correction and other interventions geared to resolving pain at its source.

Manual Therapy for LBP in Brooklyn

The pain management specialists at Physical Therapy Brooklyn work with patients one-on-one to resolve LBP based on individual clinical diagnosis. We go beyond treating your symptoms of back pain to get to its source and correct it. If you are suffering from low back pain in Brooklyn, contact Back to Health to visit one of our convenient Brooklyn locations. You will soon discover why Physical Therapy Brooklyn is reputed to offer the very best physical therapy in Brooklyn.


Paige, Neil M., et al. “Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis.” Jama 317.14 (2017): 1451-1460.