Trying to Compare Manual Manipulation and Activator for Low Back Pain

Researching low back pain is a very difficult task. We are trying to use human subjects and comparing differences between treatment types. Below is a good indication on why it is difficult to get great research studies that give us fantastic data on how to treat an individual. In a clinical setting they utilize threeoffices. Two of the offices utilized manual manipulation for low back pain. The third office utilized Activator Technique. Each office was given up to eight visits to d treat theperson as they normally would treat a patient.

People’spain scores and disability scores were measured at the time they started treatment and four weeks afterwards. The patients showed improvement that was very similar between the three offices. A statistical significant differences between manual manipulation and Activator Technique could not be drawn from the data. Especially considering other treatment modalities were utilized in the offices, such as heat, ice, electric, traction, exercises, and stretches.

In a clinical setting we are commonly responding to how you are doing each and every day. We will utilize different therapeutic modalities based on your level of improvement. This makes it very difficult for a study research design because of the changing variables and treatments that are provided.

The good news is that people got better after four weeks of chiropractic care with either manual manipulation or Activator Technique. They improved similarly in all three offices. Unfortunately for the study it did not provide a better treatment protocol for clinical providers to use on future patients. It didgive the researchers help on how to design the next studies to control and limit treatment variables.

The following article discusses back pain and exercises for back pain. The abstract is below for your reading. More information on neck pain and exercise videos for strength and endurance.

More information on therapeutic treatments utilizing Physical Therapy or Chiropractic can be directed to Google+.

Journal of Manipulative and Physiological Therapeutics

Volume 33, Issue 3 , Pages 193-200, March 2010

Mechanical vsManual Manipulation for Low Back Pain: An Observational Cohort Study

Michael J. Schneider, DC, PhD, Jennifer Brach, PhD, PT, James J. Irrgang, PhD, PT, ATC, Katherine VerdoliniAbbott, PhD, Stephen R. Wisniewski, PhD, Anthony Delitto, PhD, PT



This is an observational prospective cohort study to explore the treatment effect of mechanical vsmanual manipulation for acute low back pain.


Ninety-two patients with a history of acute low back pain were recruited from 3 private chiropractic offices, 2 of which used manual lumbar manipulation and 1 used mechanical instrument manipulation (Activator) astheir primary modes of treatment. The chiropractors used their “treatment-as-usual” protocols for a maximum of 8 visits or 4 weeks, whichever occurred first. Primary outcome measures were changes in Numeric Pain Rating Scale (NPRS) and OswestryDisabilityIndex (ODI) scores from baseline to 4 weeks. The linear regression models were adjusted for baseline NPRS and ODI scores, age, and treatment expectancy.


Comparison of baseline characteristics did not show any significant differences between the groups except for age (38.4 vs49.7 years, P < .001) and treatment expectancy (5.7 vs6.3, P = .003). Linear regression revealed significantly lower NPRS scores in the manual manipulation group at 4 weeks (β = −1.2; 95% confidence interval, −2.1 to −.28) but no significant difference in ODI scores between the 2 groups at 4 weeks (β = 1.5; 95% confidence interval, −8.3 to 2.4). Treatment expectancy, but not age, was found to have a significant main effect on both NPRS and ODI scores at 4 weeks. Exploratory analysis of the clinical patterns of care between the clinicians revealed significant differences in treatment frequency, duration, modality, and radiograph use between the 2 cohorts.


This study highlights the challenges inherent with conducting research that allows for “treatment as usual.” The data and experience derived from this investigational study will be used to design a future randomized clinical trial in which tighter controls will be imposed on the treatment protocol. PubMed

© 2010 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.