Chiropractic, osteopathy or manipulative spinal manipulation followed by exercise provides significant relief of back pain symptoms

A new study of back pain treatments, co-ordinated by researchers at the University of York, has found that spinal manipulation, in the form of chiropractic, osteopathy, or manipulative physiotherapy, followed by a programme of exercise, provides significant relief of symptoms and improvements in general health.

The study, backed by the Medical Research Council (MRC) and co-ordinated by the Trials Unit in the University's Department of Health Sciences, is the biggest of its type ever mounted in the United Kingdom. It involved more than 1,300 patients in 140 GP practices across the UK.

The UK Back pain Exercise And Manipulation (UK BEAM) randomised trial assessed the effectiveness of adding different treatments to 'best care' in general practice for patients with lower back pain, one of the most common ailments general practitioners have to treat. The results of the trial are published today (Friday, December 10) in the British Medical Journal.

The condition is painful for patients and costly to both the National Health Service and society. Until now, the benefit of different physical treatments has been unclear. 'Best care' in general practice for simple lower back pain is based on active management encouraging patients to continue with normal activities and avoid rest.

The trial recruited more than 1,300 patients, whose back pain had not improved after receiving 'best care' in general practice, to assess the effectiveness of three different treatments.

• A class-based physical exercise programme
• Spinal manipulation -- a 'hands on' approach administered by qualified therapists to move the joints of the back
• A combined package of spinal manipulation followed by a programme of exercise

The results showed that patients in all treatment groups reported improved back function and reduced pain over time, though to varying degrees. On average, patients assigned to exercise classes in addition to GP care reported a small benefit at three months but not at one year. Those assigned to spinal manipulation in addition to GP care reported a small to moderate benefit at three months and a small, on average, benefit at one year.

The greatest improvement was found in the patients assigned to combined manipulation and exercise, in addition to GP care. They reported a moderate, on average, improvement at three months and a smaller average improvement at one year. Benefits were the same whether treatment was provided in private practice or on the NHS.

While the cost to the NHS of all three treatments was modest, an economic analysis showed that both spinal manipulation and the combined package of spinal manipulation and exercise achieved similar benefits to patients at a comparable cost to the NHS. The results of this analysis, together with the local availability of physical therapists, will inform the NHS on how best to improve care for patients with lower back pain.

Simon Coulton, of the Department of Health Sciences, said: "This was the biggest trial of intervention for back pain that has ever been conducted in the UK. It found that manipulation by osteopaths, chiropractors or physiotherapists was often more cost-effective than conventional treatment."

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