Countless studies have confirmed the benefits of exercise for alleviating the symptoms of chronic back pain and other musculoskeletal conditions. Now, a recent study suggests that spinal adjustments may enhance the benefit of exercise therapy for back pain.

Often, patients with back pain are directed to perform active exercises to alleviate their symptoms. However, many avoid these exercises because they are afraid of re-injury or pain associated with movement. Since manual therapy has also been shown to alleviate back pain, a team of Swiss researchers set out to examine the results of a combination treatment involving both exercise rehabilitation and chiropractic care. They wanted to examine whether spinal adjustments could “facilitate the practice of subsequent active exercises and improve outcomes” for patients with chronic lower back pain.

The study involved 49 people with chronic back pain. Half received manual therapy immediately followed by active exercises. The other half received a sham treatment immediately followed by active exercises. The manual therapy included spinal mobilization and spinal adjustments; both techniques are frequently used by chiropractors to treat lower back pain. The active exercise program involved passive stretches, muscle and motor control exercise, mobility exercise, and strength training.

The patients received a series of eight treatments, with evaluations conducted after three and six months. Spinal adjustments were not found to significantly affect fear of movement. However, patients receiving the combination treatment reported better pain relief than those who only undertook the active exercise portion. This advantage was seen immediately following treatment and at both the three- and six-month evaluations. Those who received manual therapy also had lower disability and pain scores compared to those in the exercise-only group.

These findings suggest that a combination of spinal adjustments and exercise therapy could be a more effective spinal care program than exercise alone when treating back pain. The researchers concluded that the combination treatment “reduces significantly functional disability and tends to induce a larger decrease in pain intensity.”

This research is exactly why our spinal specialists use exercise rehabilitation in conjunction with massage therapy and chiropractic adjustments in treating lower back pain and neck pain. This integrative treatment approach has proven to be successful for thousands of our patients in St. Albans. If you are suffering from lower back pain, explore your treatment options with the spinal specialists at St. Albans Spinal Wellness Centre.


Balthazard P, et al. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskeletal Disorders 2012; 13: 162. doi:10.1186/1471-2474-13-162.