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Exercise therapy

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Exercise is an integral component of well-rounded treatment protocol utilized by doctors of chiropractic for the recovery of musculo-skeletal injury.

Neck pain

This section will review the literature related to neck and low back pain.

  • According to a 2010 systematic review by Miller et al, there is much quality evidence for manual therapy and exercise in the treatment of whiplash associated disorder (WAD). The paper states: “Favored over traditional care in reducing pain at short-term follow-up for acute WAD”. [1]
  • There is a lack of research regarding manual therapy and exercise in the treatment of neck pain with radicular symptoms [1]
  • Manual therapy and exercise improve pain and function over the long term in comparison to short term relief only with manual therapy alone. Additionally, manual therapy and exercise improve short term pain relief in comparison to exercise alone [1]
  • Manual therapy and exercise improve “pain, function, quality of life and patient satisfaction” in comparison to manual therapy alone in treatment of chronic neck pain [1]
  • Additional research is needed to determine the best manual therapy to use in combination with exercise, and vica versa. [1]
  • “Low to moderate quality evidence supports the use of specific cervical and scapular stretching and strengthening exercise for chronic neck painimmediately post treatment and intermediate term, and cervicogenic headaches in the long term”. [2]

Low Back Pain

  • Walking: There is inconclusive evidence to support walking and positive effects on LBP. More research is necessary. [3]
  • According to a 2010 paper by van Middelkoop, “Evidence from randomised controlled trials demonstrated that exercise therapy is effective at reducing pain and function in the treatment of chronic low back pain”. However it does not specify one type of exercise being more effect than another. [4]
  • Lumbar stabilization exercises: There is moderate evidence that “LSEs are effective in improving pain and function in heterogeneous group of patients with CLBP”. [4] There is strong evidence for LSE not being any more effective than a general exercise program. [4] Additionally, moderate evidence exists suggesting that LSEs are no more effective than manual therapy. [4]More research is necessary, focusing on types of patients that LSEs are most suited, as well as, “optimal setting for delivering care and training, the most effective exercises, and the optimal dose, duration, frequency, and progression”. [4]
  • Lumbar extensor strengthening exercise: The literature suggests that lumbar extensor strengthening exercise is more effective than no treatment in the short term when used alone or with co-interventions. [5] Additionally it is more effective than most passive modalities in regards to pain, disability and other patient-reported outcomes in CLBP. [5] The investigators found no clear benefit over other exercise programs. [5] And over the long-term, benefits decline versus other interventions. [5]

Rotator Cuff Impingement

Rotator cuff impingement: Investigators determined that “exercise has statistically and clinically significant effects on pain reduction and improving function, but not on range of motion or strength. Manual therapy augments the effects of exercise, yet supervised exercise was not different than home exercise programs”. [6]


  1. 1.0 1.1 1.2 1.3 1.4 Miller, J et al (Aug 2010). "Manual therapy and exercise for neck pain: a systematic review". Manual therapy 15 (4): 334-354. Retrieved 12-1-2013. 
  2. Kay, TM et al (2012 Aug). "Exercises for mechanical neck disorders.". Cochrane Database Syst Rev 15 (8): CD004250. Retrieved 12-1-2013. 
  3. Hendrick, P et al (Oct 2010). "The effectiveness of walking as an intervention for low back pain: a systematic review". Eur Spine J. 19 (10): 1613-1620. Retrieved 12-1-2013. 
  4. 4.0 4.1 4.2 4.3 4.4 van Middelkoop, M et al (Apr 2010). "Exercise therapy for chronic nonspecific low-back pain". Best Pract Res Clin Rheumatol 24 (2): 193-204. Retrieved 12-1-2013. 
  5. 5.0 5.1 5.2 5.3 Mayer, J et al (Jan-Feb 2008). "Evidence-informed management of chronic low back pain with lumbar extensor strengthening exercises". Spine J 8 (1): 96-113. Retrieved 12-1-2013. 
  6. Kuhn, JE et al (Jan-Feb 2009). "Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol". J Shoulder Elbow Surg 18 (1): 138-160. Retrieved 12-1-2013.