MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The aim of this study was to determine the short-term effectiveness of thoracic manipulation when compared to sham manipulation for individuals with low back pain (LBP).

Patients with LBP were stratified based on symptom duration and randomly assigned to a thoracic manipulation or sham manipulation treatment group. Groups received 3 visits that included manipulation or sham manipulation, core stabilization exercises, and patient education. Three physical therapists with an average of 6 years’ experience administered the treatments according to a standardised protocol. Factorial repeated-measures analysis of variance and multiple regression were performed for pain, disability, and fear avoidance.

Ninety participants completed the study. The overall group-by-time interaction was not significant for the Modified Oswestry Disability Questionnaire, numeric pain-rating scale, and Fear-Avoidance Beliefs Questionnaire outcomes. The global rating of change scale was not significantly different between groups.

The authors concluded that three sessions of thoracic manipulation, education, and exercise did not result in improved outcomes when compared to a sham manipulation, education, and exercise in individuals with chronic LBP. Future studies are needed to identify the most effective management strategies for the treatment of LBP.

This study has many features that are praiseworthy. However, others are of concern. Lumping together chronic and acute back problems might be not ideal. And why study only short-term effects?

But foremost I do wonder why manipulations were carried out on the thoracic and not the lumbar spine, the region where the pain was located. The physiotherapist authors state that the effects of thoracic manipulation on adjacent regions have been widely studied, and the majority of authors cite regional interdependence as an explanation for its success. To some degree, this might make sense. Yet, most chiropractors and osteopaths will dismiss the trial and its findings arguing that they would manipulate at the site of subluxations.

7 Responses to Thoracic spinal manipulation for low back pain is no better than sham

  • Looking at the current evidence, it appears doing SMT only above the area of complaint has little/no effect. Doing SMT only below (within reason) the area of complaint may have a positive effect.

  • I might suggest ANYTHING in the family of “pushing, pulling, probing or whacking” done while a human is lying down is fraught with pseudoscience nonsense. What ‘real’ research is available to suggest HOW any of these entrepreneurial tricks profoundly or fundamentally change the structure of the body? And if they are just generalized, superficial, transient and mercurial relievers-of-Pain (and clearly not in everyone) why are they so EXPENSIVE and require a load of cockamamy and arcane recitations from the seller? If manipulation truly worked there be no point for a skeptical blog since its results and it’s science would be manifest by now.

    • Could it be that you just do not know how to interpret the research?

      • “Could it be you just don’t know how to interpret the research“. As my Christian and Scientology ‘friends’ point out: “prayers (to the dead Jew) and Auditing (To the dead sociopath) ALWAYS work, it’s YOU that must be doing something wrong”.
        Yes perhaps you with your Doctorate-in-Subluxation are the best advisor to how to interpret research. However the Cochran reviews SEEM to do an excellent job in summarizing research so that even no-nothings like myself can get the pith of it. And it sure don’t SEEM like I’m misinterpreting it? You read it different since your income and ego are entrenched in there being a there-there. How are those Activator adjustments doing (70% of DCs use them), Drop-adjustments (70% of DCs use them), SOT “blocking” (45% of DCs use them), leg-checks, motion-palpation, subluxation-stations, nerve-charts and AK (which 100% use one or several of to determine the gullibility of the “patient” and what “segment” to aim the entrepreneurial-theatric at….unless they just stick to “cracking” every HYPERMOBILE segment they find….which fraud do you prefer?).
        Ummm. I guess I just don’t know what you know.

    • MK, perhaps you might like to explain why this works, look down the link to the article titled Investigative research

      https://www.otago.ac.nz/physio/about/otago721931.html

      In fact, you should look at all the research that Steve Tumilty has done in regard to Spinal Manual Therapy and the treatment of concussion and extremity problems.

      I hope that you studies in the legal profession are going well.

  • MK, perhaps you might like to explain why this works, look down the link to the article titled Investigative research

    Following your link, I find this:

    Until recently the biomechanical dimension has been considered the primary mechanism of effects, yet a growing body of evidence suggests that non-biomechanical factors are in fact, predominant. ‘Non-biomechanical factors’ describes these specific responses and their effects on the body’s autoimmune and neuroendocrine systems.

    and this:

    Tumilty’s current research interest explores ways in which a musculoskeletal and manual therapy approach can utilise these non-biomechanical effects to complement the body’s complex healing and remodelling processes.

    Together with a thermal image of a man showing that one foot is substantially colder than the other, with no explanation of what is going on (not even which side is supposed to be the normal one).

    It is not at all clear what is going on.

    perhaps you might like to explain why this works

    So in response to your question I would like to ask:
    Why WHAT works?

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