Spinal manipulation is as effective as other nonsurgical therapies for chronic low back pain

Reference

Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ 2019;364:l689.

Synopsis

The researchers searched 8 databases, including the Cochrane Central Register of Controlled Trials, to identify randomized controlled trials that examined the effects of spinal manipulation or mobilization in adults with or without referred pain, excluding patients with sciatica only. Spinal manipulation (high-velocity low-amplitude thrusts) is more often performed by chiropractors while mobilization (low-velocity low-amplitude movements) is more often used by osteopaths and physical therapists. The authors identified 47 studies of 9211 patients that compared these treatments with sham treatments or other active treatments in patients with back pain (at least half had pain that lasted more than 3 months). They excluded studies that were not properly randomized, though more than half of the studies had some problems with randomization or allocation concealment. Overall, on the basis of moderate-quality evidence, manipulation or mobilization techniques has a similar effect on short-term pain relief as other treatments and a small but clinically significant improvement in function (standardized mean difference -.25). The literature in this area is not very good—we need to know the percentage of people who achieve a clinically relevant response and not the average change in (already low) pain scores. There was no difference between manipulation and mobilization in 4 head-to-head studies, at least in the short term. Adverse effects due to manipulation were infrequent and minor.