Evidence does not support spinal manipulation for acute lower back pain

September 21, 2012 by Joan Vos Macdonald
Evidence does not support spinal manipulation for acute lower back pain

Manipulating or "adjusting" the spine is a popular way to treat occasional or acute lower back pain and is covered by many health insurance plans, but a recent review by The Cochrane Library finds no evidence to suggest it is more effective than other therapy options.

According to the National Institutes of Health, lower back pain affects eight out of 10 people, and is commonly caused by injury or overuse. Spinal manipulation (SMT), a technique used by chiropractors, osteopaths, naturopaths and some , is used to improve the range of motion of the joints in the spine.

"SMT is a worldwide, extensively practiced intervention; however, its effectiveness for acute lower back pain is not without dispute," said lead reviewer Sidney Rubinstein, senior researcher at the VU University Medical Center in Amsterdam.

The reviewers studied the results from 20 representing 2,674 participants with lower back pain of less than six weeks duration. Reviewers concluded that SMT neither reduced pain nor sped recovery faster than treatment options such as exercise, the use of NSAID or physiotherapy. Surprisingly, the review also found no evidence to suggest that SMT was more effective than therapies known to be ineffective. "This last finding would suggest more research is needed," said Dr. Rubinstein. If SMT is just as effective as accepted interventions, it should be better than ineffective therapies, such as using ultrasound or heat therapy.

"Such reviews may be confusing because they are not comparing apples to apples," said Mitchell Freedman, D.O., director of Physical Medicine and Rehabilitation at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia. "For a start, there are different kinds of manipulation, some more aggressive and some limited to stretching. Also, while is not useful in all circumstances, it can be in some. You do need to look across a whole spectrum."

Another complicating factor is the nature of acute . Defined as lasting six weeks or less, it tends to go away on its own in almost 90 percent of all cases."Studies do promote the use of manipulation in subacute to chronic pain which is different from acute pain," said Freedman.

Explore further: Should spinal manipulation for neck pain be abandoned?

More information: Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD008880. DOI: 10.1002/14651858.CD008880.pub2.

Related Stories

Should spinal manipulation for neck pain be abandoned?

June 7, 2012
The effectiveness of spinal manipulation divides medical opinion. On BMJ today, experts debate whether spinal manipulation for neck pain should be abandoned.

Back pain improves in first six weeks but lingering effects at one year

May 14, 2012
For people receiving health care for acute and persistent low-back pain, symptoms will improve significantly in the first six weeks, but pain and disability may linger even after one year, states a large study published in ...

Pain relief can now be based on solid evidence

September 7, 2011
A Cochrane Review of data relating to about 45,000 patients involved in approximately 350 individual studies has provided an evaluation of the effect you can expect to get if you take commonly used painkillers at specific ...

Recommended for you

Novel approach to track HIV infection

August 18, 2017
Northwestern Medicine scientists have developed a novel method of tracking HIV infection, allowing the behavior of individual virions—infectious particles—to be connected to infectivity.

Faulty gene linked to obesity in adults

August 18, 2017
Groundbreaking new research linking obesity and metabolic dysfunction to a problem in the energy generators in cells has been published by researchers from the Harry Perkins Institute of Medical Research and The University ...

Two lung diseases killed 3.6 million in 2015: study

August 17, 2017
The two most common chronic lung diseases claimed 3.6 million lives worldwide in 2015, according to a tally published Thursday in The Lancet Respiratory Medicine.

New test differentiates between Lyme disease, similar illness

August 16, 2017
Lyme disease is the most commonly reported vector-borne illness in the United States. But it can be confused with similar conditions, including Southern Tick-Associated Rash Illness. A team of researchers led by Colorado ...

Addressing superbug resistance with phage therapy

August 16, 2017
International research involving a Monash biologist shows that bacteriophage therapy – a process whereby bacterial viruses attack and destroy specific strains of bacteria - can be used successfully to treat systemic, multidrug ...

Can previous exposure to west Nile alter the course of Zika?

August 15, 2017
West Nile virus is no stranger to the U.S.-Mexico border; thousands of people in the region have contracted the mosquito-borne virus in the past. But could this previous exposure affect how intensely Zika sickens someone ...

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

PeterD
1 / 5 (1) Sep 22, 2012
Many years ago I developed acute lower back pain. I saw five back Doctors over 18 months, and none of them helped at all. I finally saw a Chiropractor, who solved my problem, quickly and permanently. If I had kept seeing the idiot Doctors, I probably would have spent the last 40 years in a wheel chair.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.