BACKGROUND: Low back pain (LBP) is a common musculoskeletal disorder causing pain and disability in most of the countries. In recent years, new approaches such as Spinal manipulation and laser therapy have been considered as an alternative to conventional exercise and also found contradicting results in terms of its effectiveness. AIM: A study to compare the combined effects of spinal manipulation, Laser and exercise versus Laser and exercise alone in chronic non-specific low back pain (cnLBP). DESIGN: Randomized control study. 330 subjects who fulfilled the selection criteria were randomized (1:1:1 ratio) into SM- LT-CE (n = 110), LT-CE (n = 110) and control group (n = 110). SETTING: Subjects with cnLBP were treated with spinal manipulation, laser and exercise in outpatient department for four weeks. The outcome measurements were visual analog scale (VAS), Modified Modified Schober Test (MMST), Roland and Morris Disability Questionnaire (RMDQ), Physical Health Questionnaire-9 (PHQ-9) and Health Related Quality of Life-4 (HRQOL-4). Baseline and follow-up measurements were measured at 4 weeks, 6 and 12 months by a blinded assessor. RESULTS: 326 subjects completed the intervention and 304 completed 12 month follow up. Demographic variables shows homogeneity between the groups and ANOVA analyses showed significant improvement (p < 0.001) in pain reduction (VAS), flexion range of motion (MMST), functional disability (RMDQ), depression status (PHQ-9) and Quality of life (HRQOL-4) in SM-LT-CE group than the other two groups over one year follow-up. CONCLUSIONS: Spinal manipulation combined with laser therapy and conventional exercise is more effective than laser therapy and conventional exercise alone in chronic non-specific low back pain. Spinal manipulation is an adjuvant intervention and it can be applied in every day clinical practice.

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