The Spine Journal 2010; 10: 918–940. -Dagenais, S, DC, PhD et al.
NASS Contemporary Concepts in Spine Care
A systematic review to assess the scientific literature related to the efficacy of spinal manipulation for acute low back pain.
This new systematic review’s conclusions are consistent with several earlier systematic reviews by prestigious multidisciplinary panels of experts (DCs, MDs, PhDs) going back to 2003.
It basically states that spinal manipulation is at least as effective as and sometimes more effective than other conservative interventions with which it has been compared.
As Haldeman, S, DC, MD, PhD and Underwood, MD noted in 2010, “there is now little dispute amongst knowledgeable scientists that SM is of value in the management of back pain, neck pain, and headaches that make up 90% or more of all chiropractic patients.”
This new data should be of considerable help to all physicians trying to practice according to the best scientific evidence, to patients seeking care and trying to decide whether chiropractic is a reasonable option, to other physicians who wish to refer patients to or work closely with DCs, and to policy makers who have to decide what treatments should be paid for.
The strength of the findings notifies all health care providers that spinal manipulation is a viable and evidence-based treatment option for acute low back pain patients and should be considered as an effective mainstream intervention.
Methods: A MEDLINE search identified 6 randomized controlled trials (RCTs) of spinal manipulation for acute low back pain (=/<3 mo) published in English. RCTs included in 2 previous SRs which were also included for a total 2,027 subjects in the 14 RCTs. Studies combined SM with education (n=5 studies), mobilization (MO) (n=4), exercise (n=3), modalities (n=3), or medication (n=2). spinal manipulation was compared with physical modalities (n=7), education (n=6), medication (n=5), exercise (n=5), MO (n=3), or sham SMT (n=2). spinal manipulation were most commonly performed by DCs (n=5) & physical therapists (PTs) (n=5). Most studies (n=6) were of 5 to 10 SM visits over 2 to 4 wks.
Outcomes: pain (n=10), function (n=10), health-care utilization (n=6), & global effect (n=5).
Studies had follow-ups of of <1 mo (n=7), 3 mo (n=1), 6 mo (n=3), 1 yr (n=2), or 2 yrs (n=1).
Results for Pain Reduction: spinal manipulation groups were superior in 3 RCTs & equivalent in 3 RCTs in the short term, equivalent in 4 RCTs in the intermediate term, & equivalent in 2 RCTs in the long term.
Results for Improvement in Function: spinal manipulation groups were superior in 1 RCT & equivalent in 4 RCTs in the short term, superior in 1 RCT & equivalent in 1 RCT in the intermediate term, & equivalent in 1 RCT and inferior in 1 RCT in the long term. No harms related to spinal manipulation were reported in these RCTs. Like many manual treatments for acute low back pain, spinal manipulation has a diminishing effect as the duration of follow-up increases.
Conclusions: Results assessing the efficacy of spinal manipulation for acute low back pain suggest that 5 to 10 treatments over 2 to 4 weeks achieve equivalent or superior improvement in pain and function compared to other commonly used interventions: physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up.
Clinicians should discuss spinal manipulation as a treatment option for acute low back pain patients who do not find adequate symptom relief with self-care and education alone.