A recent study showed that exercise and counseling was just as effective as back surgery for patients with disc degeneration.

When the discs between the vertebrae of the spine degenerate surgeons often recommend a surgical procedure, called lumbar fusion to fuse together the vertebrae above and below the problem disc(s). This takes the pressure off the disc(s) in hopes of relieving pain, but also makes it impossible to bend or twist that part of the spine anymore. That loss of flexibility and the substantial risks of any surgery should make you think twice before having this done and now a new study shows you may do as well with exercise.

Patients with low back pain lasting more than a year, who had disc degeneration shown on X-ray, were randomly divided into two groups. One group received the lumbar fusion surgery while those in the other group were given exercise and counseled, assuring them that the exercise and activity would not harm their back and recommending the exercise. After one year both groups had similar improvements in use of pain medication, emotional distress, life satisfaction, and ability to return to work. The “success rate” according to the researchers was 70% for the surgical fusion group compared to 76% for the exercise group.1

We want patients to try all conservative measures first before submitting to any surgery especially one that permanently limits the flexibility of your back. While this study used exercise alone we would have probably added adjustments to the back to relieve pain and improve function of the back, which in turn may make exercise easier and less painful to do. There may be some severe cases that still require surgery, but most people will likely find relief with chiropractic care and exercise.

1 J. Brox, et al., “Randomized Clinical Trial of Lumbar Instrumented Fusion and Cognitive Intervention and Exercises in Patients with Chronic Low Back Pain and Disc Degeneration,” September 1, 2003, Spine, Vol. 28, No. 17, pp 1913-21. (as reported by “Try Exercise Instead of Surgery for Back Pain,” December 2, 2003, To Your Health Newsletter, Vol. 4, No. 25, p. 1-2, ChiroWeb.com).

If you suffer with low back pain you know how painful it can be and how hard it makes doing just about anything.

You use back muscles for so many movements that low back pain can affect nearly all your activities and even your job. Because of this the cost of low back pain on society is enormous. Indeed low back pain is believed to cost our nation fifty billion dollars per year in time away from work, hospital bills, prescription drugs, and lost productivity.1 Because low back pain afflicts so many and has such high costs, a recent study was done on the cost effectiveness to add spinal manipulation (also known as adjustments) or exercise or both to general practitioner treatment.

The study was conducted in the United Kingdom and included 1,334 patients who had already been treated by a general practitioner for low back pain but had not improved. From there the patients were divided into four groups; a group that received no further treatment (the control group), a group that received spinal manipulation, a group that received an exercise regimen, and a group that received both.2 The manipulation care occurred over a twelve-week period and consisted of up to eight twenty-minute sessions. The exercise regimen was over an eight-week period and included eight sessions an hour long. The combined care included six weeks of manipulation followed by six weeks of exercise.3

In order to measure the success of the care patients completed questionnaires at the beginning, at three months, and at twelve months that measured disability, back pain, back pain beliefs, fear-avoidance beliefs, overall physical health, and overall mental health.4 All three groups were better off than the group that received no further treatment. Of the three the greatest improvement was seen in the manipulation and exercise group5 and the improvements were statistically significant. In addition, as one reviewer wrote, “These improvements lasted longer in patients receiving both manipulation and exercise than those who received only one type of intervention.”6 It is also worth noting that in normal practice most chiropractic doctors adjust your spine as needed and also recommend specific exercises for you to do, and so would be most like the group receiving both in this study.

Patients who had not improved under the care of a general practitioner got significantly better with additional chiropractic care and exercise but the researchers wanted to know if this was also cost effective. After a complex cost analysis they found, “Combined treatment had the highest therapy costs but the lowest subsequent hospital costs”7 so it ended up adding less costs (to general practitioner care) than exercise alone or manipulation alone. Manipulation alone was found to be almost as cost effective as the combined treatment leading the researchers to conclude: “We believe that this is the first study… for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to care in general practice.”8 They added that, “manipulation alone probably gives better value for money than manipulation followed by exercise.”9
Of course the researchers found manipulation and exercise was cost effective even after the expenses for general practice care, which had been ineffective. We wonder why these authors did not simply recommend manipulation and exercise as the first line of care, skipping the cost of general practice care. We expect that would have been even more cost effective for the British health care system.

Chiropractic doctors have more training in the care of the spine than any other profession and perform far more spinal manipulations than any other profession as we adjust spines day in and day out. By training and repeated experience chiropractic doctors are experts in care of the spine and back pain. In addition we offer exercise advice and other modes of care like use of cold packs. And we may offer advice on diet, nutrition, and lifestyle changes to not only help your back but to improve your overall health. So if you suffer with back pain, or know anyone who does, we believe this study shows chiropractic is the best choice for effective relief with long lasting improvements while at the same time being cost effective. Call us or stop in today if you suffer with low back pain.

1 MRC Study Reinforces Effectiveness of Spinal Manipulation, Says American Chiropractic Association, ACA press release, November 29, 2004, www.amerchiro.org/media/releases/112904.shtml (as also reported by “Study Shows Manipulation Exercise Combination more Effective for Back Pain.” January 1, 2005, Dynamic Chiropractic, Vol. 23, No. 1, pp. 1& 45).
2 UK BEAM Trial Team. “United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Randomized Trial: Effectiveness of Physical Treatments for Back Pain in Primary Care.” November 29, 2004, British Medical Journal, Online First, BMJ,doi:10.1136/bmj.38282.669225.AE, p. 1.
3 Ibid., pp. 2 & 3.
4 Ibid., pp. 5 & 6.
5 Ibid., p. 1.
6 “Study Shows Manipulation Exercise Combination more Effective for Back Pain.” January 1, 2005, Dynamic Chiropractic, Vol. 23, No. 1, p. 45.
7 UK BEAM Trial Team. “United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Randomized Trial: Cost Effectiveness of Physical Treatments for Back Pain in Primary Care.” November 29, 2004, British Medical Journal, Online First, BMJ,doi:10.1136/bmj.38282.607859.AE, p. 3.
8 Ibid., p. 4.
9 Ibid., p. 5.