Research Review by Dr. Shawn Thistle©
Date: Feb. 2006
Study Title: Treatment of low back pain using acupressure and physical therapy: randomised controlled trial
Authors: Hsieh L et al.
Publication Information: British Medical Journal 2006; doi: 10.1136/bmj.38744.672616.AE
Summary: Acupressure is a complimentary and alternative therapy that follows the principles of Chinese medicine, and more specifically Chinese acupuncture. The main difference is that acupressure involves manipulating specific points with the fingers rather than using needles like traditional acupuncture.

This small study compared one month of acupressure treatments (n=6) with standard physical therapy (including pelvic manual traction, spinal manipulation, thermotherapy, infrared light therapy, electrical stimulation, and exercise therapy) for patients suffering from chronic mechanical lower back pain for longer than four months. 129 patients (average age ~50) were included in the study, each randomized to undergo 6 acupressure treatments, or 6 physical therapy treatments within one month. Follow-up questionnaires were administered at baseline, after treatment, and 6 months after the treatment period.

The main outcome measures used in this study were Chinese versions of standard outcome measures used in other low back pain studies (primarily the Roland-Morris disability questionnaire).

The results reported in this study include:
  • the acupressure group had significantly lower Roland-Morris scores after the treatment period than the physical therapy group regardless of the difference in absolute score (-3.8), or mean change from baseline (-4.64)
  • "acupressure conferred an 89% reduction in significant disability compared with physical therapy after adjustment for degree of disability at baseline" - no % reduction was reported, or could be found in the remainder of the paper for the physical therapy group
Conclusions & Practical Application: This study suggests that acupressure may be an effective treatment for low back pain. However, I feel there are some limitations in this project that may limit the applicability of these results:
  • there was very little description about the actual acupressure procedure, and no report of which specific physical therapy interventions were used
  • no indication was given regarding the experience of the physical therapist(s?), while only one therapist provided all of the acupressure treatments
  • subjects were not excluded if they had recently received treatment for their back pain, which may have affected their response to treatment provided within the study
  • the positive result in the acupressure group was reportedly maintained at the six month follow-up, despite the loss of 15% of the study participants (quite a few for an already limited group of subjects)
  • the improvements reported on the Roland-Morris questionnaire may have been statistically significant, but were not large
Acupressure may be a promising treatment technique for lower back pain. Perhaps it is best when combined with other treatments. Larger trials with appropriate design are required to further clarify the role of acupressure, as well as attempt to standardize the technique for clinical application.