Does the addition of visceral manipulation alter outcomes for patients with low back pain? A randomized placebo controlled trial

Eur J Pain. 2015 Aug;19(7):899-907. doi: 10.1002/ejp.614. Epub 2014 Nov 7.


Background: This study aimed to investigate whether the addition of visceral manipulation, to a standard physiotherapy algorithm, improved outcomes in patients with low back pain.

Methods: Sixty-four patients with low back pain who presented for treatment at a private physiotherapy clinic were randomized to one of two groups: standard physiotherapy plus visceral manipulation (n = 32) or standard physiotherapy plus placebo visceral manipulation (n = 32). The primary outcome was pain (measured with the 0-10 Numerical Pain Rating Scale) at 6 weeks. Secondary outcomes were pain at 2 and 52 weeks, disability (measured with the Roland-Morris Disability Questionnaire) at 2, 6 and 52 weeks and function (measured with the Patient-Specific Functional Scale) at 2, 6 and 52 weeks. This trial was registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12611000757910).

Results: The addition of visceral manipulation did not affect the primary outcome of pain at 6 weeks (-0.12, 95% CI = -1.45 to 1.21). There were no significant between-group differences for the secondary outcomes of pain at 2 weeks or disability and function at 2, 6 or 52 weeks. The group receiving addition of visceral manipulation had less pain than the placebo group at 52 weeks (mean 1.57, 95% CI = 0.32 to 2.82). Participants were adequately blinded to group status and there were no adverse effects reported in either group.

Conclusions: Our study suggests that visceral manipulation in addition to standard care is not effective in changing short-term outcomes but may produce clinically worthwhile improvements in pain at 1 year.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Disability Evaluation
  • Female
  • Follow-Up Studies
  • Humans
  • Low Back Pain / rehabilitation
  • Low Back Pain / therapy*
  • Male
  • Manipulation, Orthopedic / methods*
  • Middle Aged
  • Pain Measurement
  • Physical Therapy Modalities
  • Treatment Outcome
  • Young Adult

Associated data

  • ANZCTR/ACTRN12611000757910