Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer-blinded clinical trial

J Manipulative Physiol Ther. 1996 Nov-Dec;19(9):570-82.


Objectives: To study the relative efficacy of three different treatment for chronic low back pain (CLBP). Two preplanned comparisons were made: (a) Spinal manipulative therapy (SMT) combined with trunk strengthening exercises (TSE) vs. SMT combined with trunk stretching exercises, and (b) SMT combined with TSE vs. nonsteroidal anti-inflammatory drug (NSAID) therapy combined with TSE.

Study design: Interdisciplinary, prospective, observer-blinded, randomized clinical trial with a 1-yr follow-up period. The trial evaluated therapies in combination only and was not designed to test the individual treatment components.

Setting: Primary contact, college out-patient clinic.

Patients: In total, 174 patients aged 20-60 yr were admitted to the study.

Main outcome measures: Patient-rated low back pain, disability, and functional health status at 5 and 11 wk.

Interventions: Five weeks of SMT or NSAID therapy in combination with supervised trunk exercise, followed by and additional 6 wk of supervised exercise alone.

Results: Individual group comparisons after 5 and 11 wk of intervention on all three main outcome measures did not reveal any clear clinically important or statistically significant differences. There seemed to be a sustained reduction in medication use at the 1-yr follow-up. in the SMT/TSE group. Continuance of exercise during the follow-up year, regardless of type, was associated with a better outcome.

Conclusion: Each of the three therapeutic regimens was associated with similar and clinically important improvement over time that was considered superior to the expected natural history of long-standing CLBP. For the management of CLBP, trunk exercise in combination with SMT or NSAID therapy seemed to be beneficial and worthwhile. The magnitude of nonspecific therapeutic (placebo) effects, cost-effectiveness and relative risks of side effects associated with these types of therapy need to be addressed in future studies.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Chronic Disease
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Low Back Pain / drug therapy
  • Low Back Pain / therapy*
  • Male
  • Manipulation, Orthopedic*
  • Middle Aged
  • Naproxen / therapeutic use*
  • Prospective Studies
  • Single-Blind Method
  • Treatment Outcome


  • Anti-Inflammatory Agents, Non-Steroidal
  • Naproxen