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PubMed1984

Manipulation and pain tolerance. A controlled study of the effect of spinal manipulation on paraspinal cutaneous pain tolerance levels.

The response of paraspinal cutaneous pain tolerance levels to spinal manipulation has not been studied in an experimental model. This paper proposes such a model of pain tolerance measurement and describes the results of a controlled study of 50 assymptomatic subjects. The group receiving a spinal manipulation demonstrated a 140% increase in local cutaneous pain tolerance levels which was statistically significant (p less than 0.05). This is consistent with previous hypotheses regarding the mode of action of manipulation in the relief of spinal pain.

Adult↗
PubMed2006

Spinal manipulation in physical therapist professional degree education: A model for teaching and integration into clinical practice.

Spinal manipulation for low back complaints is an intervention supported by randomized clinical trials and its use recommended by clinical practice guidelines. Physical therapists in this country and internationally have used thrust spinal manipulation at much lower-than-expected rates, despite evidence supporting its efficacy for the treatment of acute low back pain (LBP). The purpose of this clinical commentary is to describe a physical therapist professional degree curriculum in thrust spinal manipulation and outline a method of monitoring ongoing student performance during the clinical education experience. Increased emphasis on evidence-based decision making and on the psychomotor skills of thrust spinal manipulation was introduced into a physical therapist professional degree curriculum. As part of ongoing student performance monitoring, physical therapy students on their first full-time (8-week) clinical education experience, collected practice pattern and outcome data on individuals with low back complaints. Eight of 18 first-year students were in outpatient musculoskeletal clinical settings and managed 61 individuals with low back complaints. Patients were seen for an average (+/-SD) of 6.2 +/- 4.0 visits. Upon initial visit the student therapists employed spinal manipulation at a rate of 36.2% and spinal mobilization at 58.6%. At the final visit, utilization of manipulation and mobilization decreased (13% and 37.8%, respectively), while the utilization of exercise interventions increased, with 75% of patients receiving some form of lumbar stabilization training. Physical therapist students used thrust spinal manipulation at rates that are more consistent with clinical practice guidelines and substantially higher then previously reported by practicing physical therapists. Education within an evidence-based framework is thought to contribute to practice behaviors and outcomes that are more consistent with best practice guidelines.

Clinical Competence↗
PubMed2001

Comparison of effects of spinal manipulation and massage on motoneuron excitability.

The purpose of this study was to compare the magnitude and duration of motoneuron inhibition occurring as a sequel to spinal manipulation or paraspinal and limb massage. The physiologic mechanisms involved in spinal manipulative therapy and massage therapy are largely unknown. One possible hypothesis is based upon the theory that these two distinct and different modalities may attenuate the activity of alpha motoneurons. Both modalities have been reported to produce short-term inhibition of motoneurons. Asymptomatic volunteers were randomly assigned to either a spinal manipulation, massage, or control group. Baseline tibial nerve H-reflex amplitudes were obtained prior to the application of either lumboscaral spinal manipulation or paralumbar and limb massage. Post-interventional H-reflex recordings were recorded immediately following the application of either modality. Spinal manipulation significantly (p < 0.05) attenuated alpha motoneuronal activity immediately post-therapy, as measured by the amplitude of the tibial nerve H-reflex. Massage subjects exhibited no significant reduction in motoneuronal activity immediately following administration. Spinal manipulation produced a transient attenuation of alpha motoneuronal excitability. Paraspinal and limb massage did not inhibit the motoneuron pool as measured immediately post-therapy. These findings support the supposition that spinal manipulation procedures lead to short-term inhibitory effects on motoneuron excitability to a greater magnitude than massage.

Adult↗
PubMed1995

The relationship between methodological quality and conclusions in reviews of spinal manipulation.

OBJECTIVE: To study the relationship between the methodological quality and other characteristics of reviews of spinal manipulation for low back pain on the one hand and the reviewers' conclusions on the effectiveness of manipulation on the other hand. DATA SOURCES: Reviews identified by MEDLINE search, citation tracking, library search, and correspondence with experts. STUDY SELECTION: English- or Dutch-language reviews published up to 1993 dealing with spinal manipulation for low back pain that include at least two randomized clinical trials (RCTs). DATA EXTRACTION: Methodological quality was assessed using a standardized criteria list applied independently by two assessors (range, 0% to 100%). Other extracted characteristics were the comprehensiveness of the search, selective citation of studies, language, inclusion of non-RCTs, type of publication, reviewers' professional backgrounds, and publication in a spinal manipulation journal or book. The reviewers' conclusions were classified as negative, neutral, or positive. DATA SYNTHESIS: A total of 51 reviews were assessed, 17 of which were neutral and 34 positive. The methodological quality was low, with a median score of 23%. Nine of the 10 methodologically best reviews were positive. Other factors associated with a positive reviewers' conclusion were review of spinal manipulation only, inclusion of a spinal manipulator in the review team, and a comprehensive literature search. CONCLUSIONS: The majority of the reviews concluded that spinal manipulation is an effective treatment for low back pain. Although, in particular, the reviews with a relatively high methodological quality had a positive conclusion, strong conclusions were precluded by the overall low quality of the reviews. More empirical research on the review methods applied to other therapies in other professional fields is needed to further explore our findings about the factors related to a positive reviewers' conclusion.

Humans↗
PubMed2004

Spinal manipulation postepidural injection for lumbar and cervical radiculopathy: a retrospective case series.

OBJECTIVE: To describe the safety and potential therapeutic benefit of spinal manipulation postepidural injection in the nonsurgical treatment of patients with cervical and lumbar radiculopathy. METHODS: The study design was a retrospective review of outcomes of 20 cervical and 60 lumbar radiculopathy patients who underwent spinal manipulation postepidural injection in a hospital setting. Patients received either fluoroscopically guided or computed tomography (CT)-guided epidural injection of a combination of lidocaine and Depo-Medrol. The manual therapy consisted of an immediate postepidural application of flexion distraction mobilization and then high-velocity, low-amplitude spinal manipulation to the affected spinal regions. Outcome criteria were empirically defined as significant improvement, temporary improvement, or no change. The minimum follow-up time for all patients was 1 year. RESULTS: There were no complications associated with spinal manipulation, whereas 3 complications associated with the epidural injection procedure were noted. Of lumbar spine patients, 36.67% (n = 22) noted significant improvement, 41.67% (n = 25) experienced temporary improvement, and 21.67% (n = 13) reported no change. Of the patients undergoing spinal manipulation after cervical epidural injection, 50% (n = 10) noted significant improvement, 30% (n = 6) experienced temporary improvement, whereas 20% (n = 4) exhibited no change. CONCLUSIONS: These data suggest that spinal manipulation postepidural injection is a safe nonsurgical procedure to use in the treatment of the patient with radiculopathy of spinal origin. This is also the first report of the use of spinal manipulation postepidural injection in the cervical spine.

Adult↗
PubMed1983

Spinal manipulative therapy. A status report.

Spinal manipulative therapy is one of the most commonly used treatments for patients with low back pain. It is both a manual diagnostic and a treatment method. Manual diagnosis includes the palpation of vertebral position, vertebral motion, joint play, end feel, soft tissue texture changes, and muscle contracture. Manipulative treatment can be divided into seven categories: long-lever, nonspecific manipulation; specific, short-lever high-velocity spinal adjustments; active or functional manipulation; mobilization; manual traction; soft tissue massage; and point pressure manipulation. Clinical experience with manipulation for low back pain is extensive, and controlled observations show that it is possible to produce immediate relief of pain in some cases. The effectiveness of manipulation is greatest in patients who have acute pain and no leg pain or neurologic deficits. Long-term effects of manipulation have not been demonstrated. Manipulation appears to increase spinal range of motion and straight leg raising but is not known to reduce intervertebral disc herniations. Complications following manipulation, although rare, can be catastrophic.

Back Pain↗
PubMed2002

Does spinal manipulative therapy help people with chronic low back pain?

A systematic review of randomised clinical trials was conducted to assess the effect of spinal manipulative therapy on clinically relevant outcomes in patients with chronic low back pain. Databases searched included EMBASE, CINAHL, MEDLINE and PEDro. Methodological assessment of the trials was performed using the PEDro scale. Where there was sufficient homogeneity, a meta-analysis was conducted. Nine trials of mostly moderate quality were included in the review. Two trials were pooled comparing spinal manipulative therapy and placebo treatment, and two other trials were pooled comparing spinal manipulative therapy and non-steroidal anti-inflammatory drugs (NSAIDs). Spinal manipulative therapy reduced pain by 7mm on a 100mm visual analogue scale (95% CI 1 to 14) at one month follow-up when compared with placebo treatment, and by 14mm (95% CI -11 to 40) when compared with NSAIDs. Spinal manipulative therapy reduced disability by 6 points (95% CI 1 to 12) on a 100-point disability questionnaire when compared with NSAIDs. It is concluded that spinal manipulation does not produce clinically worthwhile decreases in pain compared with sham treatment, and does not produce clinically worthwhile reductions in disability compared with NSAIDs for patients with chronic low back pain. It is not clear whether spinal manipulation is more effective than NSAIDs in reducing pain of patients with chronic low back pain.

Chronic Disease↗
PubMedDate not supplied

Comparison of human lumbar facet joint capsule strains during simulated high-velocity, low-amplitude spinal manipulation versus physiological motions.

BACKGROUND CONTEXT: Spinal manipulation (SM) is an effective treatment for low back pain (LBP), and it has been theorized that SM induces a beneficial neurophysiological effect by stimulating mechanically sensitive neurons in the lumbar facet joint capsule (FJC). PURPOSE: The purpose of this study was to determine whether human lumbar FJC strains during simulated SM were different from those that occur during physiological motions. STUDY DESIGN/SETTING: Lumbar FJC strains were measured in human cadaveric spine specimens during physiological motions and simulated SM in a laboratory setting. METHODS: Specimens were tested during displacement-controlled physiological motions of flexion, extension, lateral bending, and axial rotations. SM was simulated using combinations of manipulation site (L3, L4, and L5), impulse speed (5, 20, and 50 mm/s), and pre-torque magnitude (applied at T12 to simulate patient position; 0, 5, 10 Nm). FJC strains and vertebral motions (using six degrees of freedom) were measured during both loading protocols. RESULTS: During SM, the applied loads were within the range measured during SM in vivo. Vertebral translations occurred primarily in the direction of the applied load, and were similar in magnitude regardless of manipulation site. Vertebral rotations and FJC strain magnitudes during SM were within the range that occurred during physiological motions. At a given FJC, manipulations delivered distally induced capsule strains similar in magnitude to those that occurred when the manipulation was applied proximally. CONCLUSIONS: FJC strain magnitudes during SM were within the physiological range, suggesting that SM is biomechanically safe. Successful treatment of patients with LBP using SM may not require precise segmental specificity, because the strain magnitudes at a given FJC during SM do not depend upon manipulation site.

Aged↗
PubMed2003

Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies.

BACKGROUND: Low back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low back pain. PURPOSE: To resolve the discrepancies related to use of spinal manipulative therapy and to update previous estimates of effectiveness by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis. DATA SOURCES: MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Register, and previous systematic reviews. STUDY SELECTION: Randomized, controlled trials of patients with low back pain that evaluated spinal manipulative therapy with at least 1 day of follow-up and at least one clinically relevant outcome measure. DATA EXTRACTION: Two authors, who served as the reviewers for all stages of the meta-analysis, independently extracted data from unmasked articles. Comparison treatments were classified into the following seven categories: sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful (traction, corset, bed rest, home care, topical gel, no treatment, diathermy, and minimal massage). DATA SYNTHESIS: Thirty-nine RCTs were identified. Meta-regression models were developed for acute or chronic pain and short-term and long-term pain and function. For patients with acute low back pain, spinal manipulative therapy was superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results. CONCLUSIONS: There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.

Acute Disease↗
PubMed2006

A systematic review of systematic reviews of spinal manipulation.

OBJECTIVES: To systematically collate and evaluate the evidence from recent systematic reviews of clinical trials of spinal manipulation. DESIGN: Literature searches were carried out in four electronic databases for all systematic reviews of the effectiveness of spinal manipulation in any indication, published between 2000 and May 2005. Reviews were defined as systematic if they included an explicit and repeatable inclusion and exclusion criteria for studies. RESULTS: Sixteen papers were included relating to the following conditions: back pain (n=3), neck pain (n=2), lower back pain and neck pain (n=1), headache (n=3), non-spinal pain (n=1), primary and secondary dysmenorrhoea (n=1), infantile colic (n=1), asthma (n=1), allergy (n=1), cervicogenic dizziness (n=1), and any medical problem (n=1). The conclusions of these reviews were largely negative, except for back pain where spinal manipulation was considered superior to sham manipulation but not better than conventional treatments. CONCLUSIONS: Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.

Asthma↗
PubMed2000

Does spinal manipulation have specific treatment effects?

OBJECTIVE: To investigate the question whether or not spinal manipulation is associated with specific treatment effects. METHODS: Literature searches were carried out in Medline, Embase and The Cochrane Library. All sham-controlled trials of spinal manipulation were considered. RESULTS: Seven such studies were located. Their methodological quality was variable but three trials adhered to the highest standards of scientific rigour. Collectively these data do not show therapeutic effects beyond placebo. In particular, the three most rigorous studies were negative. CONCLUSION: The few sham-controlled trials that do exist show that this methodology is, in principle, applicable also to spinal manipulation. The results available to date suggest that the therapeutic success of spinal manipulation is largely due to a placebo effect.

Humans↗
PubMed1998

The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache.

BACKGROUND: Migraine headache affects approximately 11 million adults in the United States. Spinal manipulation is a common alternative therapy for headaches, but its efficacy compared with standard medical therapies is unknown. OBJECTIVE: To measure the relative efficacy of amitriptyline, spinal manipulation and the combination of both therapies for the prophylaxis of migraine headache. DESIGN: A prospective, randomized, parallel-group comparison. After a 4-wk baseline period, patients were randomly assigned to 8 wk of treatment, after which there was a 4-wk follow-up period. SETTING: Chiropractic college outpatient clinic. PARTICIPANTS: A total of 218 patients with the diagnosis of migraine headache. INTERVENTIONS: An 8-wk course of therapy with spinal manipulation, amitriptyline or a combination of the two treatments. MAIN OUTCOME MEASURES: A headache index score derived from a daily headache pain diary during the last 4 wk of treatment and during the 4-wk follow-up period. RESULTS: Clinically important improvement was observed in both primary and secondary outcomes in all three study groups over time. The reduction in headache index scores during treatment compared with baseline was 49% for amitriptyline, 40% for spinal manipulation and 41% for the combined group; p = .66. During the posttreatment follow-up period the reduction from baseline was 24% for amitriptyline, 42% for spinal manipulation and 25% for the combined group; p = .05. CONCLUSION: There was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.

Adolescent↗
PubMedDate not supplied

Spinal manipulative therapy for low back pain.

Growing interest in complementary and alternative medicine in the United States has been paralleled by increased use of spinal manipulative therapy in an attempt to manage symptoms of low back pain, spinal stenosis, and spondylolisthesis. Chiropractors have been the main practitioners of spinal manipulative therapy, with osteopaths and physical therapists providing a smaller fraction of these services. Theories explaining the mode of action of spinal manipulative therapy are largely preliminary and have focused on the mechanical effects of manipulative forces on the spine and neurologic responses to manipulation. The effects of spinal manipulation on patients with both acute and chronic low back pain have been investigated in randomized clinical trials. Most reviews of these trials indicate that spinal manipulative therapy provides some short-term benefit to patients, especially with acute low back pain.

Acute Disease↗
PubMedDate not supplied

Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: a pilot randomized clinical trial.

BACKGROUND: To date, no substantiated studies have been performed to investigate the efficacy of spinal manipulative therapy on thoracic spinal syndromes. OBJECTIVE: To investigate the effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain. STUDY DESIGN: A single-blind, randomized, comparative, controlled pilot study. SETTING: Technikon Natal Chiropractic Clinic in Durban, South Africa. PARTICIPANTS: Thirty subjects selected from the general population (from 16 to 60 years old) were randomly divided into two different treatment groups of 15 each. METHODS: The objective measurements collected were the thoracic spine ranges of motion with the BROM II goniometer and pain threshold with an algometer. The subjective information required completion of the Oswestry Back Pain Disability Index, short-form McGill Pain Questionnaire, and Numerical Pain Rating Scale-101 Questionnaire by the patient. These 3 forms and objective measurements were collected before the first and final treatment and again at the 1-month follow-up consultation. The data gathered were then statistically analyzed with use of a 95% confidence level. The nonparametric Mann-Whitney U test and the Wilcoxon signed-rank test were used to compare intergroup and intragroup data, respectively. This was conducted at the alpha =.05 level of confidence. Further assessment of the data was conducted by use of power analysis. INTERVENTIONS: The treatment group received thoracic spinal manipulation. The placebo group received nonfunctional ultrasound application only. The research project was carried out so that both groups received 6 treatments over a period of 2 to 3 weeks. A 1-month follow-up appointment was scheduled after the final treatment to assess the relative long-term benefits of the two different treatments. RESULTS: Statistically significant results (P < or = .025) were noted for the percentage of pain experienced (Numerical Pain Rating Scale) and for right and left lateral flexion during intergroup comparison after the final treatment. The final treatment results were maintained at the 1-month follow-up consultation; however, there were no further statistically significant results. It was noted that the power was weak, so the probability of committing type II error (falsely accepting the null hypothesis) for the other measurements was high. The intragroup analysis showed statistically significant improvements in the group that received spinal manipulative therapy in both subjective and objective measurements between the first to final treatment and the first treatment to the 1-month follow-up consultation. The placebo group analysis showed a statistically significant improvement in sensory pain only (subjective measurement) between the first treatment and the final treatment. CONCLUSIONS: This pilot study suggests that spinal manipulative therapy has greater benefits than placebo treatment. The sample size was small, therefore the findings of this trial study should not be considered conclusive but rather should be used as a foundation for planning future studies. In further studies a larger sample size will be necessary to identify subtle changes in measurement parameters and to add to the validity of the results.

Adolescent↗
PubMedDate not supplied

Bilateral simultaneous optic nerve dysfunction after periorbital trauma: recovery of vision in association with with chiropractic spinal manipulation therapy.

OBJECTIVE: To discuss the recovery of optic nerve function after chiropractic spinal manipulation in a patient with loss of vision as a result of facial fracture from a fall. CLINICAL FEATURES: In a fall down a stairwell, a 53-year-old woman with migraines fractured her right zygomatic arch, which was later treated surgically. Approximately 3 weeks after the accident, vision in her contralateral eye became reduced to light perception. Electrophysiologic studies revealed that the function of both optic nerves was diminished, the right significantly more than the left. Single photon emission tomography showed pancerebral ischemic foci. INTERVENTION AND OUTCOME: Chiropractic spinal manipulation was used to aid recovery of vision to normal over a course of 20 treatment sessions. At times, significant improvement in vision occurred immediately after spinal manipulation. Progressive recovery of vision was monitored by serial visual field tests and by electrophysiologic studies. Unfortunately, the patient refused a further single photon emission tomographic study when visual recovery was complete. CONCLUSION: This case report adds to previous accounts of progressive and expeditious recovery of optic nerve function in association with spinal manipulation therapy.

Chiropractic↗
PubMed2002

Ruptured cervical disc after spinal manipulation therapy: report of two cases.

STUDY DESIGN: Case reports of ruptured cervical disc after spinal manipulation therapy. OBJECTIVES: To present the rare cases of ruptured cervical disc temporally related to spinal manipulation therapy. SUMMARY OF BACKGROUND DATA: The complication of ruptured cervical disc was rare in the literature. METHODS: Two patients developed cervical myelopathy or radiculopathy after spinal manipulation therapy, and magnetic resonance imaging showed herniated cervical discs at C4-C5 and C6-C7, respectively. RESULTS: Anterior cervical discectomy was performed, and ruptured disc fragments were removed in these two patients. Both patients had good neurologic recovery after operation, and no neurologic deficits were noted after 15 and 6 months of follow-up, respectively. CONCLUSIONS: The experience of these two patients reminds us that cervical disc rupture can occur during a course of cervical spinal manipulation. Full neurologic recovery is achievable if accurate diagnosis and prompt surgical treatment are done.

Adult↗
PubMedDate not supplied

Active range of motion in the cervical spine increases after spinal manipulation (toggle recoil).

BACKGROUND: It has generally been assumed that spinal manipulation has the biomechanical effect of increasing spinal range of motion. Past research has shown that there are likely no lasting changes to passive range of motion, and it is unclear whether there is an increase in active range of motion after manipulation. OBJECTIVE: To study changes in active cervical range of motion after spinal manipulation of the cervical spine. DESIGN: A double-blind randomized controlled trial at the outpatient clinic Phillip Chiropractic Research Centre, RMIT University, Melbourne, Australia. METHODS: One hundred five patients with cervicogenic headache were randomized into 2 groups. After a baseline observation period, Group 2 received manipulation (toggle recoil) to the cervical spine, whereas Group 1 received sham manipulation. In the next trial phase, Group 1 received manipulation, whereas Group 2 received no treatment. This was followed by the final trial phase, in which Group 2 received sham manipulation and Group 1 received no treatment. After each trial phase, active range of cervical motion was measured with a strap-on head goniometer by 2 blinded examiners. RESULTS: After receiving spinal manipulation, active range of motion in the cervical spine increased significantly (P < .0006) in Group 2 compared with Group 1, and this difference between the treatment groups disappeared after the third trial phase in which Group 1 also received manipulation, as expected. CONCLUSION: Spinal manipulation of the cervical spine increases active range of motion.

Adult↗
PubMed1996

Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials.

STUDY DESIGN: Systematic review of randomized clinical trials. OBJECTIVES: To assess the efficacy of spinal manipulation for patients with low back pain. SUMMARY OF BACKGROUND DATA: The management of low back pain remains controversial. Spinal manipulation is a widely used treatment option for low back pain. Recently issued clinical guidelines suggest that spinal manipulation may be effective for patients with acute low back pain. METHODS: A computer-aided search for published papers was conducted, and the methods of the studies identified were assessed. Scores were assigned for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation and analysis), the conclusion of authors regarding spinal manipulation, and the results based on the main outcome measure. RESULTS: Thirty-six randomized clinical trials comparing spinal manipulation with other treatments were identified. The highest score of a trial was 60 points (maximum score was set at 100 points), indicating that most were of poor quality. Nineteen studies (53%) showed favorable results for manipulation. In addition, five studies (14%) reported positive results in one or more subgroups only. Among the five studies with 50-60 points, three were positive, and two were positive only for a subgroup of the study population. Eleven trials compared manipulation with some placebo therapy, with inconsistent results. There appeared to be no clear relation between the methodologic score and the overall outcome of the studies. Twelve trials included patients with acute low back pain only. Of these, five reported positive results, four reported negative results, and three reported positive results in a subgroup of the study population only. There were eight trials comparing manipulation with other conservative treatment modalities, focusing on patients with subacute or chronic low back pain. Of these, five reported positive results, two reported negative results, and in one study no conclusion was presented. There were only 16 studies that included an effect measurement of at least 3 months. In only six of these do the authors report positive effects of manipulation. CONCLUSIONS: The efficacy of spinal manipulation for patients with acute or chronic low back pain has not been demonstrated with sound randomized clinical trials. There certainly are indications that manipulation might be effective in some subgroups of patients with low back pain. These impressions justify additional research efforts on this topic. Methodologic quality remains a critical aspect that should be dealt with in future studies.

Chiropractic↗