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

The Within-Session Change in Low Back Pain Intensity Following Spinal Manipulative Therapy Is Related to Differences in Diffusion of Water in the Intervertebral Discs of the Upper Lumbar Spine and L5-S1

“…12,20,22,50 A large body of research has generally supported efficacy and effectiveness of SMT for the treatment of LBP, with overall effect-size improvements in pain following SMT that are typically modest when compared to placebo treatment or to no treatment at all. 16,19,33,[36][37][38]42,55,59,62 These findings suggest a heterogeneous response between patients receiving SMT. One cause for this variation may be explained by differences in water diffusion within the lumbar IVD.…”

The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews

“…Finally, there is limited evidence of no-difference in efficacy for MT1 combined with extension-exercises, in comparison to extension-exercises alone for pain. 64 The highest quality clinical research study is the conventional RCT. These studies have good internal validity but at the expense of external validity.…”

“…Pain recurrence and drug intake were also significantly reduced in the MT3 group (P,0.001). Rasmussen et al 64 (rated as a level B quality) compared the effects of combined MT1 (in a side-lying position at the lumbar level of reduced movement) with exercises (two different extension exercises performed as often as possible during the day and at least once per hour), to the extension exercises alone in patients with chronic LBP classified as QTF 1-3. Both groups showed clinically relevant back and leg pain reduction, and no difference between the groups could be observed at the one month and one year follow-ups.…”

The Immediate Reduction in Low Back Pain Intensity Following Lumbar Joint Mobilization and Prone Press-ups Is Associated With Increased Diffusion of Water in the L5-S1 Intervertebral Disc

“…The treatment consisted of PA pressures applied to the spinous processes of the lumbar vertebrae, as described by Maitland,40 followed by the prone pressup exercise as described by McKenzie. 42 We selected this approach because we believed that it is commonly used in clinical settings and would provide both actively and passively generated stimuli that may influence diffusion within the IVD at the lumbosacral joint; however, the conflicting evidence regarding the efficacy and effectiveness of these 2 interventions to reduce pain intensity 11,20,30,31,37,39,41,50,51 suggested that we observe a variation in the immediate change in pain intensity following this intervention. Identifying physiologic differences in response to these treatments between those subjects who report an immediate reduction in symptoms and those who do not, may help explain 1 reason for inconsistent findings in the literature.…”