Spinal Manipulation Shows Small Immediate Effects on Lifting in Back Pain Trial

People with chronic non-specific back pain often find that one of the hardest parts of daily life is the simplest: lifting. A new randomized controlled trial from Sweden now reports that three widely discussed interventions — spinal manipulation, exercise therapy, and open-label placebo — produced only limited immediate changes in how these individuals actually lifted a box, even as some subtle shifts in movement coordination and pain emerged within treatment groups.

The study, published in Chiropractic & Manual Therapies, was conducted in a motion laboratory and used a crossover randomized controlled design. Fifty individuals with chronic non-specific back pain, defined as continuous or recurrent pain persisting for more than three months, were recruited between April and July 2025 from five primary care clinics in Northern Sweden and through public advertisements. All participants attended a single laboratory session lasting approximately 60 minutes between September and October 2025, during which they received all three interventions in randomized order.

Before and after each intervention, participants performed lifting tasks with loads they themselves classified as light, between 2 and 5 kilograms, and heavy, between 6 and 15 kilograms, with the heavy load set at three times the light load. They lifted a plastic box from the floor to a table set at 50 percent of body height, positioned at 75 percent of arm length. Crucially, no instructions were given about lifting posture or technique, allowing the researchers to observe each person’s natural movement strategy rather than an imposed one.

The technical centerpiece of the study was three-dimensional motion capture. Sixteen infrared cameras operating at 120 Hz tracked 45 reflective markers placed on a tight-fitting suit and at key anatomical landmarks, including the Th7 vertebra and the box itself. From these data the researchers extracted temporal outcomes such as movement time and phase durations, spatial outcomes such as range of motion and box displacement, and spatiotemporal measures including movement speed and movement smoothness, quantified with a validated frequency-domain metric known as spectral arc length, or SPARC.

Beyond these conventional discrete measures, the team applied functional data analysis, a statistical framework that treats the entire movement trajectory as a continuous function rather than reducing it to single numbers. This allowed them to examine intersegmental coordination — the relative contribution of back versus knee movement across the lifting cycle — with positive values indicating back dominance and negative values indicating knee dominance. Permutation-based tests identified specific time intervals where coordination changed significantly.

The headline result was one of restraint. At the primary endpoint, the immediate post-intervention assessment, no significant between-group differences were observed in lifting performance or pain. Overall lifting performance changed only to a small degree following the interventions. Movement smoothness and movement speed showed no significant changes over time and did not differ between groups in either lifting condition, which the authors interpret as indicating relatively stable movement quality, possibly because baseline pain intensity and disability levels were relatively low.

Yet within-group analyses revealed patterns the discrete measures missed. Following spinal manipulation, participants showed altered intersegmental coordination during the light lift, characterized by a greater relative contribution of back movement early in the lifting phase, along with reduced thorax–pelvis tilt — used as a proxy for maximum lumbar flexion — and increased hip flexion during the heavy lift. Spinal manipulation was also the only intervention associated with a significant within-group reduction in pain, with a change of 1.12 points on an 11-point numerical rating scale, statistically significant at p < 0.001. Open-label placebo was associated with reduced thorax–pelvis tilt and increased hip and knee flexion during the light lift, and showed add-on effects for hip flexion in both lifting conditions, though these effects were inconsistent and not supported by the primary between-group comparisons.

The subjective picture diverged from the objective one. Spinal manipulation received the highest ratings for perceived effectiveness and willingness to undergo the intervention, followed by exercise therapy, with open-label placebo ranked lowest; post hoc comparisons showed significant differences between all intervention pairs. But these evaluations did not consistently correspond to the biomechanical changes measured in the laboratory, and internal consistency across the subjective measures was low, with a Cronbach’s alpha of 0.45. The authors argue this dissociation suggests that pain reduction and movement performance are at least partly independent constructs in chronic back pain, and that subjective and objective outcomes should be integrated when evaluating treatment responses.

The study also carried a methodological novelty: open-label placebo, in which participants are fully informed they are receiving a placebo, was included as an intervention in its own right. Participants watched an information video explaining that placebo effects can be potent and may occur even without a positive attitude toward treatment, then ingested two capsules clearly labeled “placebo” containing the inert substance microcrystalline cellulose. This ethical approach engages expectancy-related and conditioning mechanisms without deception, and the trial tested whether adding it to spinal manipulation or exercise therapy amplified their effects. In the add-on analysis, no significant difference in pain change was observed between treatments with and without open-label placebo.

The authors are careful about the limits of what these findings mean. The trial evaluated only immediate effects, laboratory lifting may differ from real-world movement, and the standardized setup may have constrained natural variation in lifting strategies. The power calculation was based on biomechanical variables from a previous study, and the many outcomes and analytical approaches may have increased the risk of chance findings, although only a small number of significant results emerged. Four trajectories were excluded due to marker occlusion artefacts. Whether the observed changes in coordination and segment-specific movement represent less guarded or more typical movement patterns cannot be determined from this study, and the clinical relevance of the immediate findings remains uncertain. The researchers suggest that lifting patterns associated with chronic back pain may be relatively persistent and require repeated treatment sessions over time, and they call for longer-term studies to determine whether these subtle immediate responses translate into meaningful clinical improvements.

Subject of Research: Immediate effects of spinal manipulation, exercise therapy, and open-label placebo on lifting performance and pain in chronic non-specific back pain

Article Title: Immediate effects of spinal manipulation, exercise therapy, and open-label placebo on lifting performance and pain in individuals with chronic non-specific back pain: a motion laboratory-based crossover randomized controlled trial

Article References: Borg, F., Gedin, F., Franzén, E., & Grooten, W. J. A. (2026). Immediate effects of spinal manipulation, exercise therapy, and open-label placebo on lifting performance and pain in individuals with chronic non-specific back pain: a motion laboratory-based crossover randomized controlled trial. Chiropractic & Manual Therapies, 34(1), Article 60. https://doi.org/10.1186/s12998-026-00680-w

Image Credits: AI Generated

DOI: 10.1186/s12998-026-00680-w

Keywords: chronic back pain, spinal manipulation, exercise therapy, open-label placebo, motion capture, lifting biomechanics, randomized controlled trial, functional data analysis, movement coordination, pain intensity, crossover design, rehabilitation