title: Spinal manipulation and exercise for low back pain in adolescents: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Low back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents.
  
  
  METHODS
  This study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants' perceptions of treatment.
  
  
  CONCLUSIONS
  This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents.
  
  
  BACKGROUND
  (ClinicalTrials.gov NCT01096628).
authors.affiliation: Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, 2501 W 84th St, Bloomington, MN 55431, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Schulz
authors.affiliation: Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, 2501 W 84th St, Bloomington, MN 55431, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Leininger
authors.affiliation: Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, 2501 W 84th St, Bloomington, MN 55431, USA.
authors.forename: Roni
authors.initials: R
authors.lastname: Evans
authors.affiliation: Center for Outcome Studies, University of Western States, 2900 NE 132nd Ave, Portland, OR 97230, USA.
authors.forename: Darcy
authors.initials: D
authors.lastname: Vavrek
authors.affiliation: Division of Chiropractic Sciences, University of Western States, 2900 NE 132nd Ave, Portland, OR 97230, USA.
authors.forename: Dave
authors.initials: D
authors.lastname: Peterson
authors.affiliation: Center for Outcome Studies, University of Western States, 2900 NE 132nd Ave, Portland, OR 97230, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Haas
authors.affiliation: Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, 2501 W 84th St, Bloomington, MN 55431, USA.
authors.forename: Gert
authors.initials: G
authors.lastname: Bronfort
keywords: Adolescent; Back pain; Exercise; Musculoskeletal manipulations; Pain; Randomized controlled trial; Spinal manipulation