Farley J, Taylor-Swanson L, Koppenhaver S, et al. The Effect of Combining Spinal Manipulation and Dry Needling in Individuals With Nonspecific Low Back Pain. J Pain. 2024 Mar 12:S1526-5900(24)00425-5. doi: 10.1016/j.jpain.2024.03.002. (Original study)

Low back pain (LBP) is one of the most common and costly musculoskeletal conditions impacting health care in the United States. The development of multimodal strategies of treatment is imperative in order to curb the growing incidence and prevalence of LBP. Spinal manipulative therapy (SMT), dry needling (DN), and exercise are common nonpharmacological treatments for LBP. This study is a 3-armed parallel-group design randomized clinical trial. We enrolled and randomized 96 participants with LBP into a multimodal strategy of treatment consisting of a combination of DN and SMT, DN only, and SMT only, followed by an at-home exercise program. All participants received 4 treatment sessions in the first 2 weeks followed by a 2-week home exercise program. Outcomes included clinical (Oswestry Disability Index, numeric pain intensity rating) and mechanistic (lumbar multifidus, erector spinae, and gluteus medius muscle activation) measures at baseline, 2, and 4 weeks. Participants in the DN and SMT groups showed larger effects and statistically significant improvement in pain and disability scores, and muscle percent thickness change at 2 weeks and 4 weeks of treatment when compared to the other groups. This study was registered prior to participant enrollment. PERSPECTIVE: This article presents the process of developing an optimized multimodal treatment plan utilizing SMT, DN, and exercise to address the burden of LBP for impacted individuals and the health care system. This method could potentially help clinicians who treat LBP to lower initial pain and increase exercise compliance. ( NCT05802901).

Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 6 / 7
Comments from PAIN+ CPN subscribers

Dr. Hélène Bertrand (4/26/2024 12:07 PM)

There is a much simpler and more effective way to treat "nonspecific" low-back pain (NSLBP). Most of this pain is coming from displaced pelvic bones. As these bones carry all the weight of the upper body, that weight tends to push the bones away from the sacrum where they attach. There are more ligaments trying to hold the sacroiliac (SI) joints together than any other joint. Unfortunately, as the hip joints are inside the pelvic bones, the SI joints are the body's main shock absorbers. Instead of being smooth like all the other joints, the SI joints are full of irregularities making them invisible to medical imaging, hence the term "nonspecific". A chart review I did showed that 164/180 of patients with NSLBP had uneven Posterior Superior Iliac Spine (PSIS) levels indicating displaced SI joints. When the unevenness was corrected with a two-minute exercise people can do any time the pain recurs, 90% immediately became pain free. Bertrand H, Reeves KD, Mattu R, Garcia R, Mohammed M, Wiebe E, Cheng AL. Self-Treatment of Chronic Low Back Pain Based on a Rapid and Objective Sacroiliac Asymmetry Test: A Pilot Study. Cureus. 2021 Nov 11;13(11):e19483. doi: 10.7759/cureus.19483. PMID: 34912624; PMCID: PMC8665897.