Research Shows Manual Therapy and Exercise Outperform Pills for Back Pain

Low back pain has emerged as the most expensive health issue in the United States, with Americans spending an estimated $134.5 billion in 2016 on related conditions. This figure surpasses expenditures on heart disease, cancer, or diabetes, according to JAMA Network. The condition also stands as a leading cause of work disability, contributing to hundreds of millions of lost workdays annually.

Despite the staggering costs and impact on daily life, recent research indicates that manual therapy combined with targeted exercise can effectively reduce pain and improve function. This approach is not only beneficial for patients but also serves as a cost-effective strategy for the healthcare system.

Understanding Manual Therapy and Exercise

Manual therapy encompasses a range of hands-on techniques, including spinal manipulation, joint mobilization, soft-tissue techniques, and gentle traction. When combined with an individualized exercise program, which may include mobility and stretching for the hips and spine, core strengthening, and specific training that addresses the patient’s needs, the results can be significant.

A comprehensive Cochrane review conducted in 2021 analyzed 249 trials related to exercise for chronic low back pain. The findings revealed that individuals who engaged in structured exercise reported a pain reduction of approximately 15 points on a 0–100 scale within three months. Disability scores also improved, indicating that exercise leads to meaningful gains in daily function.

Moreover, when exercise was compared to other conservative treatments, it demonstrated a noteworthy advantage, yielding about 9 points less pain and 4 points less disability than alternatives that did not involve physical activity. These improvements, while not miraculous, are significant and represent a safe and low-risk option within patient control.

The Role of Manual Therapy

The question of whether manual therapy adds value is answered positively, especially when paired with exercise. A review highlighted moderate-quality evidence indicating that spinal manipulation and mobilization significantly reduce pain and enhance function in chronic low back pain patients, yielding results comparable to recommended medications and exercise.

In cases of acute low back pain, a 2017 JAMA systematic review of 26 randomized trials found that spinal manipulative therapy led to statistically significant improvements in pain and function over the initial six-week period. The side effects were mostly minor and transient, such as temporary soreness.

A 2024 analysis of over 300 randomized trials reaffirmed that non-surgical treatments, including exercise and spinal manipulation, are among the most effective for managing back pain.

Cost-Effectiveness of Early Intervention

The financial burden of low back pain is exacerbated by the fact that only about 10% of cases are severely disabling, yet they account for an overwhelming 85% of total costs. Many patients become trapped in cycles of imaging, injections, and long-term medications, which are costly and often ineffective.

Research has shown that seeing a physical therapist as the first point of care can dramatically alter this trajectory. A significant study analyzing 150,000 insurance claims revealed that patients who consulted a physical therapist first had an 89% lower likelihood of receiving an opioid prescription, a 28% lower chance of undergoing advanced imaging, and a 15% reduction in emergency department visits.

Financially, early physical therapy represents a wise investment. One economic analysis indicated that patients who opted for early physical therapy incurred about $580 more in costs over a year compared to usual care, but they also experienced significant health benefits, achieving an extra 0.02 quality-adjusted life-years (QALYs). This translates to a cost of about $32,000 per QALY, well below the commonly accepted thresholds for cost-effectiveness in the United States.

Additionally, exercise therapy has consistently demonstrated cost-effectiveness. A 2019 systematic review concluded that exercise therapy is generally more cost-effective than usual care for managing subacute and chronic low back pain.

The implications of these findings are profound. A structured exercise program has been shown to reduce pain by 35%, decrease general practitioner visits by 29%, and cut down sick days by 50% among participants suffering from hip, knee, and back pain.

Conclusion

Low back pain is prevalent, costly, and often frustrating for those affected. Nevertheless, it is not a hopeless condition. A treatment plan emphasizing manual therapy alongside exercise presents a strong case for effective pain relief and improved quality of life. This approach not only reduces reliance on opioids and imaging but also proves to be financially beneficial for both individuals and the healthcare system.

For those experiencing back pain, consulting a physical therapist or chiropractor who prioritizes hands-on care and movement may be a wise first step.

For more information on physical therapy and treatment options, visit Mishock Physical Therapy, where Dr. Mishock, a clinician with doctorate-level degrees in both physical therapy and chiropractic, leads the team.