Immediate effects of spinal manipulation, exercise therapy, and open-label placebo on lifting performance and pain in individuals with chronic non-specific back pain: a motion laboratory-based crossover randomized controlled trial.
Fredrik Borg, Filip Gedin, Erika Franzén et al.
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In 30 seconds
This motion-laboratory crossover randomised controlled trial examined immediate effects of spinal manipulation (SMT), exercise therapy (ET), and open-label placebo (OLP) on lifting and pain in 50 individuals with chronic non-specific back pain. Participants completed light- and heavy-load lifting before and after interventions delivered in randomised order. Overall lifting performance changed only slightly, and there were no significant between-group differences at the primary endpoint. SMT was followed by some within-group changes in movement coordination and reduced pain; OLP was associated with changes in trunk and lower-limb movement during light lifting.
Key findings
- Overall lifting performance changed to a small degree, with no significant between-group differences at the primary endpoint.
- After SMT, light-lift coordination shifted toward a greater relative contribution of back movement early in lifting; heavy-lift thorax-pelvis tilt and pain decreased.
- During light lifting, OLP was associated with reduced thorax-pelvis tilt and increased hip and knee flexion.
- Subjective evaluations did not consistently correspond to objective biomechanical changes.
Why it matters
The findings suggest that immediate changes in pain or selected movement features may occur without substantial change in overall lifting performance. Combining patient-reported outcomes with objective movement assessment may therefore provide a fuller account of short-term responses to interventions for chronic non-specific back pain. The results also caution against assuming that perceived treatment effects map directly onto measured biomechanics.
What to keep in mind
The trial assessed immediate effects during a single laboratory session, so it does not establish whether changes persist or affect everyday function. No significant between-group difference was found at the primary endpoint.