Abstract
Objective
To determine the short-term effectiveness of thoracic manipulation when compared to sham manipulation for individuals with low back pain (LBP).

Design
Randomized controlled trial.

Methods
Patients with LBP were stratified based on symptom duration and randomly assigned to a thoracic manipulation or sham manipulation treatment group. Groups received 3 visits that included manipulation or sham manipulation, core stabilization exercises, and patient education. Factorial repeated-measures analysis of variance and multiple regression were performed for pain, disability, and fear avoidance. The Mann-Whitney U test was used to analyze patient-perceived improvement, via the global rating of change scale, at follow-up.

Results
Ninety participants completed the study (mean ± SD age, 38 ± 11.5 years; 70% female; 72% with chronic LBP). The overall group-by-time interaction was not significant for the Modified Oswestry Disability Questionnaire, numeric pain-rating scale, and Fear-Avoidance Beliefs Questionnaire outcomes. The global rating of change scale was not significantly different between groups.

Conclusion
Three sessions of thoracic manipulation, education, and exercise did not result in improved outcomes when compared to a sham manipulation, education, and exercise in individuals with chronic LBP. Future studies are needed to identify the most effective management strategies for the treatment of LBP.

Level of Evidence
Therapy, level 1b. J Orthop Sports Phys Ther 2020;50(1):24–32. Epub 6 Dec 2019. doi:10.2519/jospt.2020.8928

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