Karolinska Institutet
Wilhelmus Grooten
The goal of this laboratory-based cross-over randomized controlled study is to study the immediate effects Spinal manipulative therapy (SMT) and medical exercise treatment (MET) compared to open-label placebo (OLP) on movement performance, gait, active trunk mobility and pain-intensity in persons with chronic non-specific back pain. The main question this study aims to answer is: What are the immediate and measurable effects of SMT and MTT on work movements, gait, active trunk mobility and pain-intensity in people with chronic non-specific back pain, compared with and in combination with open-label placebo treatment (OP)? The investigators hypothesize that the participants, after SMT and MET, will perform the lifting task faster, and use more range of motion in most of the joints. They also believe that a greater range of motion is used during gait and that the active ROM in the back is increased, while the pain intensity scores decrease after these interventions. The investigators hypothesize that the control intervention (OLP) could be effective as an add-on intervention, but not as a single intervention. All participants will receive all three interventions SMT, MET and OLP and to study the immediate effects, the participants will be asked: * to lift a box with two different weights * to walk straight forward with and without a cognitive dual task * perform two clinical tests of active range of motion ( * rate the intensity of their pain "right now" * rank the treatment effects of these three treatment methods
Chronic Low-back Pain
Back Disorder
SMT
MET
OLP
NA
The occurrence of chronic non-specific back pain (CBP) is costly for Western society and most persons with CBP are functionally limited in their everyday movements. Studies show positive subjective short-term effects after a period of both spinal manipulative therapy (SMT) and medical exercise treatment (MET), but the immediate effects on of one session SMT/MET on movement performance are unknown. Open placebo is a relatively new field of research and a promising form of treatment for people with nonspecific pain conditions. The goal of this laboratory-based cross-over randomized controlled study is to study the immediate effects Spinal manipulative therapy (SMT) and medical exercise treatment (MET) compared to open-label placebo (OLP) on movement performance, gait, active trunk mobility and pain-intensity in persons with chronic non-specific back pain. Participants with long-term back pain will be recruited through primary care, such as health centers, private clinics and occupational health services. All participants will receive all three interventions (around 5-8 minutes each) * SMT: a doctor of chiropractic will perform HVLA spinal manipulation of areas with restricted range of motion.The areas of interest can be from the neck to the pelvis and hips. * MET: The participants will be asked to perform mobility and motor control exercises of the trunk and pelvic muscles under supervision. * OLP: The participant takes two pieces of orange gelatin capsules filled with the inactive substance microcrystalline cellulose, following the procedure described in Carvalho et al (2016). In short, participants will be informed that the pills are placebos and will be shown a news report featuring patients with non-specific complaints, such as migraines and irritable bowel syndrome, who describe their positive experiences with placebo. Movement performance will be studied in an advanced movement analyses laboratory (Qualisys) and operationalized using kinematic parameters such as movement time, relative phase time, range of motion in the spine and adjacent joints, inter-segmental coordination, etc. To study the immediate effects on movement performance, the participants will be asked to perform the following functional movements before and immediately after each intervention: * lifting a box with two different weights from just above ground level and place it on a table in front of them * walking straight forward at a self-selected walking speed with and without a cognitive dual task * two clinical tests of active range of motion (modified finger-to-floor test, and the modified m-Schober's test) Moreover, the participants are asked to: \* rate the intensity of their pain "right now" on an 11-point standard numerical rating scale (NRS) At the end of the experiment, when all interventions have been applied, the participants are asked to: \* rank the treatment effects of these three treatment methods based on their effectiveness, willingness and preference
| Study Type : | INTERVENTIONAL |
| Estimated Enrollment : | 40 participants |
| Masking : | NONE |
| Primary Purpose : | TREATMENT |
| Official Title : | Acute Effects of Spinal Manipulative Therapy, Medical Exercise and Open-label Placebo on Movement Performance in Persons with Chronic Back Pain |
| Actual Study Start Date : | 2025-09-01 |
| Estimated Primary Completion Date : | 2025-12-30 |
| Estimated Study Completion Date : | 2026-09-30 |
Information not available for Arms and Intervention/treatment
| Ages Eligible for Study: | 18 Years |
| Sexes Eligible for Study: | ALL |
| Accepts Healthy Volunteers: |
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