Date of Award

Spring 2026

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Mindy Stavetig

Keywords

chronic low back pain, spinal manipulation therapy, exercise therapy, functional disability, pain management

Abstract

Chronic non-specific low back pain is a condition that affects millions of people each year, is a leading cause of disability worldwide, and is one of the most common presenting complaints in primary care. Non-pharmacological therapies are largely regarded as the gold standard for first-line treatment, including spinal manipulation and exercise therapy. Both therapies are frequently utilized by patients and practitioners alike, however uncertainty remains as to which is superior to the other, or if a combined approach is more effective. The objective of this literature review is to evaluate whether spinal manipulation, exercise therapy, or a combination of the two is most effective for the treatment of chronic non-specific low back pain. A literature review was conducted using electronic databases PubMed, Embase, and Google Scholar. Studies included in this literature review were published within the last ten years and evaluated spinal manipulation, exercise therapy, or a combined approach in adults with chronic non-specific low back pain, with pain and functional disability as outcomes measured. The literature showed that spinal manipulation was associated with short-term reductions in pain, functional disability, and increased patient satisfaction, while exercise therapy consistently demonstrated improved long-term functional outcomes. Combined treatment approaches did not demonstrate superiority. These findings support an individualized approach, concluding that there is evidence to support early intervention with spinal manipulation therapy for short-term functional improvement if a patient is having difficulty initiating an exercise program due to pain, however these early benefits fade over time and exercise therapy continues to demonstrate superior long-term outcomes.

Comments

Note: this is a corrected draft of the student work, not the final version

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