Effect of Spinal Manipulation on Pain Sensitivity, Postural Sway, and Health-related Quality of Life among Patients with Non-specific Chronic Low Back Pain: A Randomised Control Trial

Introduction: Spinal manipulation is a technique of specific directed manual thrust which has been effective in aligning a spinal segment, maintaining normal range of motion and reducing pain. Recent studies have reported on management of pain and improvement of quality of life of patients suffering from mechanical low back pain. Aim: To analyse the effectiveness of Spinal Manipulation-High-Velocity Low Amplitude Thrust (SM-HVLA) on pain sensitivity, postural sway and quality of life in patients with Chronic Non-Specific Low Back Pain (CNSLBP). Materials and Methods: This randomised controlled trial was conducted on a sample size of 90 patients with chronic nonspecific low back pain (with duration of pain more than three months) recruited from Outpatient Department, Department of Physiotherapy, Lovely Professional University, Phagwara, Punjab, India. Participants were divided into three groups, namely Control Group, Study Group-1, and Study Group-2. Control group received supervised exercise with ergonomic advice (n=30), whereas SM-HVLA thrust with ergonomic advice (n=30), and study group-2 received core stability exercise with ergonomic advice (n=30). Primary outcomes were postural sways (centres of foot pressure) measured by Win Track Platform, and pain sensitivity measured by pressure pain threshold (digital algometer) and quality of life measured by EuroQoL questionnaire score at two weeks and four weeks. Univariate analysis of variance (ANOVA) with post-hoc Tukey's multiple comparison tests was carried out to examine treatment effects and the relationship between groups changes across outcome measures. Results: For all three treatment groups, outcomes improved after two weeks of treatment. The group received spinal manipulation with ergonomic advice had slightly better outcome than the supervised exercise with ergonomic advice group at two weeks (between-group difference) in pain sensitivity (p=0.001); Postural sway (p=0.001); quality of life (p=0.01) as well as at four weeks (between-group difference): pain sensitivity (p=0.001); postural sway (p=0.001); quality of life (p=0.01). Conclusion: The spinal manipulation with ergonomic advice is effective in treatment of chronic non-specific low back pain. This is an economic model of back care in clinics can be practised widely.