Almost everyone will get some lumbar pain over the years. Between its poor design, improper usage and our often poor posture- lumbar pain effects 88-97% of people at some point. Is exercise, manual therapy, acupuncture or another therapeutic modality the way to go when it comes to controlling pain and restoring function?
Attempting to determine the best treatments both for patient outcomes and for obvious economic and time allocation resource factors has been a serious matter for some time. Standaert et al 1976 compared manual therapy, exercise therapy and acupuncture for chronic low back pain. There was sufficient evidence to show that manual therapy and exercise therapy have about equal strength in spinl rehab while acupuncture’s data set was inconclusive. Bronfort et al 2004, a more recent review clearly demonstrate that manual therapy is the best modality for chronic low back pain. Interestingly, the study by Assendelft et al 2003 demonstrates no clear difference between manual therapy, exercise therapy, analgesic use and postural retraining. It is also worthwhile to check how many low back cases get seen by therapists. Freburger et al 2011 found that less than 30% of patients with chronic low back pain get seen by a physiotherapist and about the same proportion saw a chiropractor. We can see that if fewer than 60% of those with back pain are seeking out those who can treat the back pain, a major communication gap exists between the therapists and the community at large. Greater targeting of the average patient and improved understanding of what can be done is needed.
So what have we learned? First, it appears that manual therapy and exercise therapy have similar effects on low back pain in terms of dealing with the pain and improved mobility and strength. Second, those in the rehabilitative fields need to create platforms with which they can communicate with the public more effectively as almost 1 in 2 are not seeking their aide.