In 2004, the British Medical Journal published the UK BEAM (United Kingdom Back Pain, Exercise, and Manipulation) study.  This was a randomized trial to test the effectiveness of various physical treatments for back pain.  The study showed that manipulation provided the greatest response to care for patients with un-resolving lower back pain; and if cost or time is an issue, manipulation alone provided a greater net benefit than exercise alone.

Manipulation/Adjustments alone had statistically significant improvement in the Roland Disability Score for the manipulation group at 3 months (1.57) and remained significant at 12 months (1.01).  The exercise only group was significant at 3 months (1.36) and not at all at 12 months (.39).  When examining the treatment groups, the most robust separation from the baseline Roland Disability Scores were the treatment groups that included manipulation.  Additionally, you will notice that no serious advance effects were recorded. 

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