Physiotherapy 92 (2006) 34–42 A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain Mohammad A. Mohseni-Bandpei a,∗ , Jacqueline Critchley b , Thomas Staunton c , Barbara Richardson d a Rehabilitation Department, School of Medicine, Khazar Boulevard, P.O. Box 48168, Sari, Mazandaran, Iran b Department of Physiotherapy, Norfolk and Norwich Hospital, Norwich, UK c Department of Neurology, Norfolk and Norwich Hospital, Norwich, UK d School of Allied Health Professions, Norwich, UK Abstract Objectives To assess the short- and long-term effectiveness of spinal manipulation therapy, and to identify the effect of manipulation on lumbar muscle endurance in patients with chronic low back pain (LBP). Design A randomised controlled trial comparing manipulation and exercise treatment with ultrasound and exercise treatment. Setting An outpatient physiotherapy department. Participants One hundred and twenty patients with chronic LBP were allocated at random into the manipulation/exercise group or the ultrasound/exercise group. Interventions Both groups were given a programme of exercises. In addition, one group received spinal manipulation therapy and the other group received therapeutic ultrasound. Main outcome measures Pain intensity, functional disability, lumbar movements and muscle endurance were measured shortly before treatment, at the end of the treatment programme and 6 months after randomisation using surface electromyography. Results Following treatment, the manipulation/exercise group showed a statistically significant improvement (P = 0.001) in pain intensity [mean 16.4 mm, 95% confidence interval (CI) 6.1–26.8], functional disability (mean 8%, 95% CI 2–13) and spinal mobility (flexion: mean 9.4 mm, 95% CI 5.5–13.4; extension: mean 3.4 mm, 95% CI 1.0–5.8). There was no significant difference (P = 0.068) between the two groups in the median frequency of surface electromyography (multifidus: mean 6.8 Hz, 95% CI 1.24–14.91; iliocostalis: mean 2.4 Hz, 95% CI 2.5–7.1), although a significant difference (P = 0.013) was found in the median frequency slope of surface electromyography in favour of spinal manipulation for multifidus alone (mean 0.3, 95% CI 0.1–0.5). A significant difference was also found between the two groups in favour of the manipulation/exercise group at 6-month follow-up. Conclusions Although improvements were recorded in both groups, patients receiving manipulation/exercise showed a greater improvement compared with those receiving ultrasound/exercise at both the end of the treatment period and at 6-month follow-up. © 2005 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. Keywords: Low back pain; Manipulation; Electromyography; Muscle endurance; Ultrasound Introduction It is well documented that low back pain (LBP) is a common and costly condition [1–5]. LBP and its associated impairment and disability are significant medical and social ∗ Corresponding author. Tel.: +98 151 2262743; fax: +98 151 2273634. E-mail address: Mohseni Bandpei@yahoo.com (M.A. Mohseni-Bandpei). problems [6–8]. Sixty to eighty percent of people will suffer at least one episode of LBP sometime in their lives [9–11], and 30–40% of these will experience LBP each year [12,13]. Whilst many recover regardless of the treatment they are given, a minority of patients seem resistant to treatment and develop chronic pain and disability [14–16]. Chronic LBP, or LBP lasting for more than 3 months [7,17,18], is more difficult to treat and the outcome is less certain. Despite an increasing number of clinical and basic research studies in 0031-9406/$ – see front matter © 2005 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.physio.2005.05.005