The effect of frequent and infrequent chiropractic treatments in the management of mechanical low back pain

Abstract

This comparative, randomized, controlled clinical trial consisted of sixty patients, suffering from low back pain (LBP) attributable to sacroiliac and/or lumbar facet syndrome. The aim of the study was to determine the relative effectiveness of frequent and infrequent chiropractic treatments in the management of mechanical low back pain. It was hypothesised that the Frequent Treatment Group would produce better results than the Infrequent Treatment Group. Treatments consisted of spinal manipulative therapy (SMT) using diversified techniques to dysfunctional sacroiliac (SI) and or lumbar facet joints. All treatments were preceded with 5 minutes soft tissue therapy to the lumbar region. The study population was randomly divided into two treatment groups. The Frequent -Treatment Group received 9 treatments over a three-week period and the Infrequent Treatment Group received 3 treatments over the same treatment period. Data was collected before the treatment commenced and again at the beginning of the second and third weeks of the trial and finally the week following the last treatment. Subjective data gathered included results from the Numerical Pain Rating Scale 101 and the Oswestry Low Back Pain Disability Questionnaires. Objective data included an orthopedic rating scale used to assess the sacroiliac and lumbar facet joints and lumbar spine range of motion (ROM) as measured with the BROM II goniometer. Data obtained during the trial period was statistically analysed. No significant difference between the two treatment groups was found at the 95% level of confidence. These findings imply that once weekly treatments are as effective as three treatments per week in terms of the clinical measure employed in this study. The results from this study suggest that patients who receive treatments more than once a week could be receiving excessive treatments, which would make the cost of chiropractic treatment unnecessarily expensive. Intra-group analysis of the results indicated that both treatment groups improved significantly (0 =0.05) between the first and final consultation, for all measures. These findings demonstrate that chiropractic treatment is beneficial to patients with mechanical LBP. The mean values obtained for each group for the levels of pain intensity, disability, ROM and joint dysfunction show the Frequent Treatment Group to have improved slightly more than the Infrequent Treatment Group, however not significant at the 95 % level of confidence. The cost of more frequent treatment needs to be justified with superior long-term effects. Research into factors such as whether or not more frequent treatments maintain productivity and avoid chronicity may provide support for more frequent treatments.