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Joint Bone Spine. 2008 Dec;75(6):708-13. doi: 10.1016/j.jbspin.2007.12.011. Epub 2008 Nov 22.

Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study.

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The Parker Institute, Copenhagen University Hospital at Frederiksberg, Denmark.



Both exercises and manipulation are recommended as basic therapy in back diseases, while a possible synergistic effect of these treatments have not been clarified. This study was conducted to test a possible further effect of manipulation as adjunct to extension exercises for unspecific LBP.


72 patients with chronic LBP (mean 12 months) were examined by a specialist in manual medicine, who detected localized binding between the lumbar segments. All patients were instructed in extension exercises, while randomized to either pretreatment with specific manipulation or control. The patients were blinded to the manipulation, which was performed at the end of the manual examination, and repeated after two and four weeks. The manipulator only knew the group of the particular patient just before manipulation by the end of the examination. The primary end point was pain, measured by a visual analogue scale.


Pain in both back and leg decreased without differences between groups. Segmental binding of the low-back was associated with persisting clinical symptoms at four weeks.


No additional effect was demonstrated of manipulation, when extension exercises were used as basic therapy.

[Indexed for MEDLINE]

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