Narenthiran Pirunthaban, Granville Smith Isabelle, Williams Frances M K
Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
J Bodyw Mov Ther. 2025 Jun;42:146-152. doi: 10.1016/j.jbmt.2024.12.004. Epub 2024 Dec 10.
Low back pain (LBP) is a common musculoskeletal problem and the leading cause of disability worldwide. Manual therapy and exercise therapy are used by physiotherapists to treat LBP. The evidence base for exercise is strong, however less so for manual therapy. We investigated whether manual therapy in addition to exercise provides improvements in pain and disability outcomes over exercise alone for LBP.
A PRISMA guided systematic review protocol was developed. PubMed, Ovid and Web of Science were searched for randomised controlled trials (RCTs) which compared manual therapy plus exercise with exercise alone for LBP patients. Participants consisted of adults and older adults suffering from chronic back pain for over three months, recruited by researchers following examination by a health professional. Exercise prescriptions consisted of strengthening, stretching and stabilisation exercises. Manual therapies included spinal manipulation, massage, soft tissue mobilisation, myofascial release and muscle energy technique. The main outcome measures were pain (VAS, The McGill Pain Questionnaire) and disability (ODI, Quebec Back Pain Disability Scale). Secondary outcome measures included quality of life, flexibility, strength, spinal mobility, satisfaction.
Ten studies met the inclusion criteria: eight reported pain and/or disability improvements with the addition of manual therapy, two reported no benefit.
This systematic review found that manual therapy as an adjunct to exercise provides increased improvements in short-term pain, function and disability outcomes than exercise alone in the management of LBP. The addition of manual therapy is recommended for at least short-term pain and disability relief in LBP patients.
腰痛是一种常见的肌肉骨骼问题，也是全球致残的主要原因。物理治疗师使用手法治疗和运动疗法来治疗腰痛。运动疗法的证据基础很充分，然而手法治疗的证据则相对较少。我们研究了对于腰痛患者，手法治疗联合运动疗法相较于单纯运动疗法，在疼痛和功能障碍方面是否能带来更大改善。
制定了一项遵循PRISMA指南的系统评价方案。检索了PubMed、Ovid和科学网，查找比较手法治疗联合运动疗法与单纯运动疗法治疗腰痛患者的随机对照试验（RCT）。参与者包括患有慢性背痛超过三个月的成年人及老年人，由研究人员在健康专业人员检查后招募。运动处方包括强化、拉伸和稳定练习。手法治疗包括脊柱推拿、按摩、软组织松动术、肌筋膜松解术和肌肉能量技术。主要结局指标为疼痛（视觉模拟评分法、麦吉尔疼痛问卷）和功能障碍（Oswestry功能障碍指数、魁北克腰痛功能障碍量表）。次要结局指标包括生活质量、灵活性、力量、脊柱活动度、满意度。
十项研究符合纳入标准：八项研究报告了添加手法治疗后疼痛和/或功能障碍有所改善，两项研究报告无益处。
该系统评价发现，在腰痛管理中，手法治疗作为运动疗法的辅助手段，相较于单纯运动疗法，在短期疼痛、功能和功能障碍结局方面能带来更大改善。建议对腰痛患者至少在短期疼痛和功能障碍缓解方面添加手法治疗。
