Trial reportEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2006
A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain.
Trial report in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02592642 (Self-Management to Improve Walking Ability in Degenerative Lumbar Spinal Stenosis), which is not on this map. Cited by 50 papers, 12 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Self-Management to Improve Walking Ability in Degenerative Lumbar Spinal Stenosis: the Evaluation of Four Novel Strategies.
Who cites it
50 citing papers in PubMed, 12 syntheses or guidelines pooled it, 131 citations in OpenAlex.
- Spinal manipulative therapy in older adults with chronic low back pain: an individual participant data meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022Pooled it
- Exercise therapy for chronic low back pain.The Cochrane database of systematic reviews · 2021Pooled it
- Manual Therapy in Cervical and Lumbar Radiculopathy: A Systematic Review of the Literature.International journal of environmental research and public health · 2021Pooled it
- Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials.BMJ (Clinical research ed.) · 2019Pooled it
- Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis.The spine journal : official journal of the North American Spine Society · 2018Pooled it
- Assessment of variability in traction interventions for patients with low back pain: a systematic review.Chiropractic & manual therapies · 2018Pooled it
- Traction for low-back pain with or without sciatica.The Cochrane database of systematic reviews · 2013Pooled it
- Spinal manipulative therapy for chronic low-back pain.The Cochrane database of systematic reviews · 2011Pooled it
- A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2011Pooled it
- A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2010Pooled it
- Combined chiropractic interventions for low-back pain.The Cochrane database of systematic reviews · 2010Pooled it
- How do we define the condition 'recurrent low back pain'? A systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2010Pooled it
- Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding.Journal of manipulative and physiological therapeutics · 2013Trial
- Trial
- Recruitment and enrollment for the simultaneous conduct of 2 randomized controlled trials for patients with subacute and chronic low back pain at a CAM research center.Journal of alternative and complementary medicine (New York, N.Y.) · 2008Trial
- The Boot Camp treatment program for patients with lumbar spinal stenosis in Danish chiropractic care-a feasibility study.Pilot and feasibility studies · 2025Article
- Ultrasound measurements of lumbar spinous process movement during flexion distraction manipulation: a preliminary descriptive cross-sectional study with healthy participants.Chiropractic & manual therapies · 2025Article
- Migraine resolution in a patient receiving CoxThe Journal of the Canadian Chiropractic Association · 2025Article
- Self-Administered Traction as an Adjunct in the Chiropractic Treatment of Low Back Pain: A Case Report.Journal of chiropractic medicine · 2024Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 1 country.
Funding
Abstract
Many clinical trials on chiropractic management of low back pain have neglected to include specific forms of care. This study compared two well-defined treatment protocols. The objective was to compare the outcome of flexion-distraction (FD) procedures performed by chiropractors with an active trunk exercise protocol (ATEP) performed by physical therapists. A randomized clinical trial study design was used. Subjects, 18 years of age and older, with a primary complaint of low back pain (>3 months) were recruited. A 100 mm visual analogue scale (VAS) for perceived pain, the Roland Morris (RM) Questionnaire for low back function, and the SF-36 for overall health status served as primary outcome measures. Subjects were randomly allocated to receive either FD or ATEP. The FD intervention consisted of the application of flexion and traction applied to specific regions in the low back, with the aid of a specially designed manipulation table. The ATEP intervention included stabilizing and flexibility exercises, the use of modalities, and cardiovascular training. A total of 235 subjects met the inclusion/exclusion criteria and signed the informed consent. Of these, 123 were randomly allocated to FD and 112 to the ATEP. Study patients perceived significantly less pain and better function after intervention, regardless of which group they were allocated to (P<0.01). Subjects randomly allocated to the flexion-distraction group had significantly greater relief from pain than those allocated to the exercise program (P=0.01). Subgroup analysis indicated that subjects categorized as chronic, with moderate to severe symptoms, improved most with the flexion-distraction protocol. Subjects categorized with recurrent pain and moderate to severe symptoms improved most with the exercise program. Patients with radiculopathy did significantly better with FD. There were no significant differences between groups on the Roland Morris and SF-36 outcome measures. Overall, flexion-distraction provided more pain relief than active exercise; however, these results varied based on stratification of patients with and without radiculopathy and with and without recurrent symptoms. The subgroup analysis provides a possible explanation for contrasting results among randomized clinical trials of chronic low back pain treatments and these results also provide guidance for future work in the treatment of chronic low back pain.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.