• Gopal Nambi, Walid Kamal, Shanmugananth Es, Siddhart Joshi, and Parth Trivedi.
• Department of Physical Therapy and Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdul Aziz University, Al-Kharj, Saudi Arabia - physio_gopal@rediffmail.com.
• Eur J Phys Rehabil Med. 2018 Dec 1; 54 (6): 880-889.

BackgroundLow back pain (LBP) is a common musculoskeletal disorder causing pain and disability in most of the countries. In recent years, new approaches such as Spinal manipulation and laser therapy have been considered as an alternative to conventional exercise and also found contradicting results in terms of its effectiveness.AimA study to compare the combined effects of spinal manipulation, Laser and exercise versus Laser and exercise alone in chronic non-specific low back pain (cnLBP).DesignRandomized control study.SettingSubjects with cnLBP were treated with spinal manipulation, Laser and exercise in outpatient department for four weeks.PopulationThree hundred and thirty subjects who fulfilled the selection criteria were randomized (1:1:1 ratio) into SM-LT-CE (N.=110), LT-CE (N.=110) and control group (N.=110).MethodsThe outcome measurements were Visual Analog Scale (VAS), Modified Modified Schober Test (MMST) Roland and Morris Disability Questionnaire (RMDQ), Physical Health Questionnaire-9 (PHQ-9) and Health Related Quality of Life-4 (HRQOL-4). Baseline and follow-up measurements were measured at 4 weeks, 6 and 12 months by a blinded investigator.ResultsThree hundred and twenty-six subjects completed the intervention and 304 completed the 12-month follow-up. Demographic variables show homogeneity between the groups and ANOVA analyses showed significant improvement (P<0.001) in pain reduction (VAS), flexion range of motion (MMST), functional disability (RMDQ), depression status (PHQ-9), and quality of life (HRQOL-4) in SM-LT-CE group compared to the other two groups at one-year follow-up.ConclusionsSpinal manipulation combined with laser therapy and conventional exercise is more effective than laser therapy and conventional exercise alone in chronic non-specific low back pain.Clinical Rehabilitation ImpactSpinal manipulation is an adjuvant intervention and it can be applied in every day clinical practice.

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