The Effectiveness of Spinal Manipulation Relative to Other Therapies for Low Back Pain FREE

Low back pain is a common problem that often goes away after several days or weeks, but in some persons may persist for months or years. The main goal in treating low back pain is to decrease pain and allow patients to resume their normal activities. Some doctors and researchers assume that various traditional treatments are helpful for low back pain; these include drugs (pain killers, anti-inflammatory drugs, and muscle relaxants), physical therapy, back exercises, and education about ways to prevent back injury and to deal with back pain (sometimes called back school). Some treatments have been shown to be unhelpful; they include traction, bed rest, corsets, topical gels, heat therapy, and certain types of massage. Spinal manipulation is an alternative treatment for low back pain. For spinal manipulation, a specially trained person (chiropractor, osteopathic physician, or physical therapist) uses his or her hands to move the bones in the spine. Some guidelines for the treatment of low back pain recommend spinal manipulation, while others do not. One of the reasons experts disagree about the role of spinal manipulation in the treatment of low back pain is that some have compared it to a mix of traditional therapies rather than to each therapy individually.

To compare spinal manipulation to other individual therapies for low back pain.

Rather than do a new study, the authors looked at published studies. Patients included in these previous studies were the focus of this work.

The researchers searched the medical literature by using computerized databases to find studies that compared spinal manipulation to one of seven categories of other treatments for low back pain: general practitioner care, pain killers, physical therapy, exercises, back school, a collection of ineffective therapies (for example, traction, bed rest, and heat therapy), or sham manipulation. Sham manipulation meant that the patients thought they were getting spinal manipulation but were not. The therapists just touched their backs without performing the specific movements involved in real spinal manipulation. The researchers found 39 studies that met these criteria and collected information about each study and its results. Then they used a method called meta-analysis to combine the results of studies that looked at the same category of treatment and calculated the effectiveness of spinal manipulation compared with that treatment.

Spinal manipulation was more effective than sham therapy and therapies already known to be unhelpful. However, it was no more or less effective than general practitioner care, pain killers, physical therapy, exercise, or back school.

The effectiveness of spinal manipulation compared with other therapies may change as new studies are done and new drugs or new spinal manipulation techniques are developed. In addition, many patients with low back pain receive several types of treatment at once.

This analysis suggests that spinal manipulation is no more or no less effective than traditional therapies for low back pain.