Evidence Does Not Back-Up Spinal Manipulation for Acute Lower Back Pain

Release Date: September 20, 2012 | By Joan Vos MacDonald, Contributing Writer
Research Source: The Cochrane Library


  • Acute lower back pain, defined as pain lasting six weeks or less, resolves on its own in most cases.
  • Spinal manipulation, often used by chiropractors and osteopaths, is no more effective than exercise, NSAIDs or other physical therapy to treat acute lower back pain.
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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 medical doctors, 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 randomized controlled trials 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 pain medications 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 spinal manipulation 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 lower back pain. 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.

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The Cochrane Library (http://www.thecochranelibrary.com) contains high quality health care information, including systematic reviews from The Cochrane Collaboration. These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions.

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.

Tags for this article:
Pain   Complementary and Alternative Medicine  

Comments on this article
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Sonja says
September 23, 2012 at 12:02 PM

Debuking the "science" of Chiropractic "medicine":


Oz says
September 23, 2012 at 3:14 PM

Well, my anecdotal case disputes this - and rather dramatically. About 10 years ago, I was standing, and bent over to put on a sock. *Something* happened at that instant, and an intense pain in the lower back - and I do mean intense - made me fall over - I simply suddenly could not stand.

The pain was excruciating, and I could barely move. I was right next to my bed, and it took me 45 minutes to finally get back onto it. I could not, lying on my back, lift any part of my body without blinding pain. While not technically paralyzed, I was, for practical purposes.

This lasted without change for almost 3 days, before I finally could convince a chiropractor to come to my house. I live where there are two stories of stairs to navigate before getting into a car, and that was, simply, impossible. At this time (the 3rd day), I was peeing into a cup, and unable to get out of bed at all.

The chiropractor showed up, did his manipulation, and I could get up. I could not quite stand up straight, but I could get up, and walk about. You can barely imagine the dramatic difference this made - the pain was reduced to a twinge that only was really bad if I tried to stand very straight. Over the next 48 hours, even that abated completely. This has never recurred.

So, much to the contrary of the study's findings, I would say in this case, the benefit was clear, lasting, and economical - far more so than pain drugs could have been.

I wonder if "acute lower back pain" isn't poorly defined, admitting a lot of people who would not benefit properly from this sort of handling. I doubt most were as "acute" as mine. Perhaps the value of the result therefore would be related more to the acuteness of the pain. More mile pain might well have more equivocal results.