When you see the word, Chiropractor, there are a number images that people conjure up; both positive and negative. One of the most common images is the image of back pain. Back pain is one of the most common ailments that people come in to see me at my chiropractic office. Spinal manipulation is often used in my treatments, in addition to Active Release Techniques, acupuncture and corrective exercises.
This blog is a continuation of a blog post seeking out the evidence of the above image. Though I have not found the specific statements in the research regarding the effectiveness of manipulation on lower back pain here is what the evidence says in the literature.
I would like to comment on some of the findings you will read in this post. When a conclusion is made that says that there is no evidence that the treatment is superior to other forms of treatment this doesn’t mean that it is not effective. What it does mean is that it is equally as effective as those treatments. That’s a good thing. It means it is a viable option for care for back pain.
Check out some of the research. Read the highlights, read the entire abstract or seek out the full paper. If you have questions seek out further information or just ask and I’ll try and find that information for you.
Lower Back Pain
In 2007 guidelines, the American College of Physicians and the American Pain Society included spinal manipulation as one of several treatment options for practitioners to consider when low-back pain does not improve with self-care. More recently, a 2010 Agency for Healthcare Research and Quality (AHRQ) report noted that complementary health therapies, including spinal manipulation, offer additional options to conventional treatments, which often have limited benefit in managing back and neck pain. The AHRQ analysis also found that spinal manipulation was more effective than placebo and as effective as medication in reducing low-back pain intensity. However, the researchers noted inconsistent results when they compared spinal manipulation with massage or physical therapy to reduce low-back pain intensity or disability.
Researchers continue to study spinal manipulation for low-back pain.
Researchers are investigating whether the effects of spinal manipulation depend on the length and frequency of treatment. In one study funded by NCCAM that examined long-term effects in more than 600 people with low-back pain, results suggested that chiropractic care involving spinal manipulation was at least as effective as conventional medical care for up to 18 months. However, less than 20 percent of participants in this study were pain free at 18 months, regardless of the type of treatment used.
Researchers are also exploring how spinal manipulation affects the body. In an NCCAM-funded study of a small group of people with low-back pain, spinal manipulation affected pain perception in specific ways that other therapies (stationary bicycle and low-back extension exercises) did not.
Cochrane systematic review of randomized controlled trials.
To determine the effects of combined chiropractic interventions on pain, disability, back-related function, overall improvement, and patient satisfaction in adults with low-back pain (LBP).
SUMMARY OF BACKGROUND DATA:
Chiropractors commonly use a combination of interventions to treat people with LBP, but little is known about the effects of this care.
We used a comprehensive search strategy. All randomized trials comparing combined chiropractic interventions (rather than spinal manipulation alone) with no treatment or other therapies were included. At least two authors selected studies, assessed bias risk, and extracted data. Descriptive synthesis and meta-analyses were performed.
We included 12 studies involving 2887 LBP participants. Three studies had low risk of bias. Included studies evaluated a range of chiropractic procedures in a variety of subpopulations with LBP. For acute and subacute LBP, chiropractic interventions improved short- and medium-term pain (standardized mean difference [SMD] -0.25 [95% CI: -0.46 to -0.04] and MD -0.89 [95%CI: -1.60 to -0.18]) compared with other treatments, but there was no significant difference in long-term pain (MD -0.46 [95% CI -1.18 to 0.26]). Short-term improvement in disability was greater in the chiropractic group compared to other therapies (SMD -0.36 [95% CI: -0.70 to -0.02]). However, the effect was small and studies contributing to these results had high risk of bias. There was no difference in medium- and long-term disability. No difference was demonstrated for combined chiropractic interventions for chronic LBP and studies that had a mixed population of LBP.
Combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions.