Comparison of Effectiveness of Chiropractic Spinal Manipulation and Conservative Therapy for Low Back Pain
Journal of Orthopedics and Sports Medicine
January 3, 2023; Vol. 5; No. 1; pp. 1-8
Emmanuel Wong, Wai Ting Lee, Cherrie Chau, Hay Yeung Cheng, Ronald Kwok. From Mctimoney College of Chiropractic, Ulster University, United Kingdom. This study cites 77 references.
The objective of this study was to describe the evidence for the effectiveness of chiropractic spinal manipulation in comparison to the conservative intervention on low back pain (LBP). The authors searched PubMed for randomized clinical trials (RCTs) of spinal manipulation and LBP; 8 papers met their inclusion criteria.
KEY POINTS FROM THIS ARTICLE:
1) “LBP has now been called ‘the hidden military danger’ because of its associated expenses of human suffering, healthcare, and disabilities, as well as the accompanying reduced ability of personnel to perform military actions.”
- “For the time being, no one therapy technique has been identified as the gold standard therapy for low back pain.”
- “SMT which is delivered by chiropractors, is a regularly utilized treatment that has consistently excellent effects in terms of pain intensity and functionality.”
- “Clinical practice recommendations for patients with acute, subacute, and chronic LBP suggest chiropractic therapy or spinal manipulation as a scientific proof, cost-effective, conservative treatment approach.”
2) “Chiropractic care is a healthcare profession which focuses on hands-on treatment.”
- Spinal Manipulation Technique (SMT) refers to high velocity and low amplitude adjustment to “restore and sustain general health and well-being by treating the spine.”
3) “Chiropractors have long been visited for musculoskeletal conditions such as headache, dizziness, facial pain, neck pain, temporomandibular joint pain, shoulder pain, back pain, knee pain, and scoliosis; inflammatory arthritis such as rheumatoid arthritis; and other neurodegenerative disorders.”
4) “Some chiropractors believe that chiropractic care can help to avoid health issues as well as maintain health and fitness.”
- “Research discovered that 40% of patients pursue chiropractic therapy expressly for illness prevention and posture improvement.”
5) “The World Health Organization (WHO) defines chiropractic as ‘a health care profession focused with the diagnosis, treatment, and prevention of problems of the neuromusculoskeletal system, as well as the implications of such illnesses on overall health.’”
- “Manual procedures, such as joint adjustment and/or manipulation, are utilized, with a special emphasis on subluxation.”
6) “Chiropractors believe that the body as a whole is connected, and that the body can sustain its health if the body’s integrity is preserved.”
- “There are also suggestions that chiropractic could help with a variety of non-musculoskeletal symptoms such as visual disturbance, angina and cardiovascular symptoms, dysphagia and gastrointestinal disorders, and testicular pain and reproductive dysfunctions.”
7) These authors cite studies that show:
- “Spinal manipulation or mobilization is beneficial for acute, subacute, and chronic LBP in adults.”
- “Spinal manipulation or mobilization is recommended as an effective therapy for acute, subacute, and chronic LBP by four guidelines in total which include National Institute for Health and Care Excellence (NICE), The American College of Physicians Pain Society, European guidelines for chronic LBP, and European guidelines for acute LBP.” [Important]
- “There is strong evidence that spinal manipulation or mobilization is a viable therapy choice for people suffering with subacute and chronic LBP.”
- A sports chiropractic manual therapy intervention is the best practice multi-disciplinary medical, paramedical, and sports science management for athletics.
- Manual-Thrust Manipulation (MTM) versus Mechanical-Assisted Manipulation (MAM) versus Usual Medical Care (UMC) found that MTM provided greater short-term reductions in disability and pain scores compared to UMC or MAM. [Important]
- There was also a significant advantage of MTM at 4 weeks compared to MAM and UMC.
- A RCT comparing the effects of manual therapy to general exercise therapy in chronic LBP patients found that the “Manual Therapy (MT) group showed significantly large[er] improvements than the Exercise Therapy (ET) group on all outcome variables throughout the entire experimental period.”
8) “RCTs have demonstrated that chiropractic care and its signature treatment, spinal manipulation, is an effective conservative care option for patients with LBP.”
- “They have concluded that improvements in pain and disability were significantly greater in the chiropractic care group.” [Important]
9) “When it comes to adopting the principle of ‘do no harm’, chiropractic has a significant advantage.” [Important]
- “Chiropractic, and especially SMT, is typically safe, according to different research literature.”
- “Research suggests that the risk of major harm from SMT is incredibly minimal.”
- “Almost all of the side effects associated with SMT are temporary and small.”
- “SMT has a high safety rating, particularly in comparison to alternative therapeutic methods.”
10) Manual-Thrust Manipulation (MTM) is different than Mechanical-assisted Manipulation (MAM) approaches.
- MTM is the most prevalent method of manipulation by chiropractors.
- Mechanical tools are marketed as safe and efficient replacements to manual-thrust manipulation.
- In comparing MAM to MTM, the MTM group had a minimum 25% better response for both outcomes and degrees of improvement. [Important]
- “These data dispute the hypothesis that these two manipulation strategies are therapeutically equivalent.”
- MTM resulted with larger short-term pain and disability improvements than MAM and usual medical care.
11) Manual therapy has a “significant beneficial impact on chronic LBP and had been preferable to medical treatment, bed rest, and educational advice in a study of clinical studies involving individuals with chronic LBP.”
- “The manual therapy group outperformed the standard exercise therapy group with all outcome measures, such as pain, functional impairment, health in general, range of motion in the spine, and return to work.”
12) Conclusions:
- “Either chiropractic spinal manipulation alone or integrative care is effective for patients with acute, subacute, and chronic LBP in reducing pain, increasing range of motion, improving disability, enhancing general health and returning to work.”
- “Chiropractic care seems to be more effective than conservative intervention for LBP in reducing pain, increasing range of motion in lumbar spine, improving disability status, and enhancing general health.” [Key Point]
- Chiropractic spinal manipulation alone could reduce LBP effectively.
- “There is no need to expand chiropractic’s treatment scope.”
We have reviewed many studies supporting this article, including:
Article Review 12-03: Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation
Article Review 34-04: Long-Term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes
Article Review 8-07: Spinal Manipulation in the Treatment of Low back Pain
Article Review 49-07: Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment
Article Review 10-15: Short-Term Effect of Spinal Manipulation on Pain Perception, Spinal Mobility, and Full Height Recovery in Male Subjects with Degenerative Disk Disease
Article Review 40-17:
Low Back Pain and Pain Resulting from Lumbar Spine Conditions: A Comparison of Treatment Results
Article Review 25-17: Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain
Article Review 1-18: Manipulation in Back Pain
Article Review 11-23: Randomized Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain
Article Review 42-24:
Reduction of Chronic Low Back Pain by Spinal Manipulative Therapy
