Spinal manipulative therapy for acute low-back pain

Abstract

Background Many therapies exist for the treatment of low-back pain including spinal manipulative therapy (SMT), which is a worldwide, extensively practised intervention. This report is an update of the earlier Cochrane review, first published in January 2004 with the last search for studies up to January 2000. Objectives To examine the effects of SMT for acute low-back pain, which is defined as pain of less than six weeks duration. Search methods A comprehensive search was conducted on 31 March 2011 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PEDro, and the Index to Chiropractic Literature. Other search strategies were employed for completeness. No limitations were placed on language or publication status. Selection criteria Randomized controlled trials (RCTs) which examined the effectiveness of spinal manipulation or mobilization in adults with acute low-back pain were included. In addition, studies were included if the pain was predominantly in the lower back but the study allowed mixed populations, including participants with radiation of pain into the buttocks and legs. Studies which exclusively evaluated sciatica were excluded. No other restrictions were placed on the setting nor the type of pain. The primary outcomes were back pain, backpain specific functional status, and perceived recovery. Secondary outcomes were return-to-work and quality of life. SMT was defined as any hands-on therapy directed towards the spine, which includes both manipulation and mobilization, and includes studies from chiropractors, manual therapists, and osteopaths. Data collection and analysis Two review authors independently conducted the study selection and risk of bias (RoB) assessment. Data extraction was checked by the second review author. The effects were examined in the following comparisons: SMT versus 1) inert interventions, 2) sham SMT, 3) other interventions, and 4) SMT as an additional therapy. In addition, we examined the effects of different SMT techniques 1 Spinal manipulative therapy for acute low-back pain (Review)

Improved Chronic Low Back Pain, Radiographic Alignment, and Patient Reported Outcomes Following Postural Rehabilitation Protocols: A Case Series of Two Patients with 18- and 26-Months Follow-Up

“…Non-specific chiropractic SMT and general SMT increases ROM and improves pain briefly; however, no known studies have repeatable long-term improvement in subjective/objective outcome measures [ 26 ]. This result is consistent with our two patients who received general SMT from chiropractors prior to this intervention without long-term reduction in symptoms or disability [ 27 , 28 ].…”

Improved Chronic Low Back Pain, Radiographic Alignment, and Patient Reported Outcomes Following Postural Rehabilitation Protocols: A Case Series of Two Patients with 18- and 26-Months Follow-Up

“…Non-specific chiropractic SMT and general SMT increases ROM and improves pain briefly; however, no known studies have repeatable long-term improvement in subjective/objective outcome measures [ 26 ]. This result is consistent with our two patients who received general SMT from chiropractors prior to this intervention without long-term reduction in symptoms or disability [ 27 , 28 ].…”

Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies

“…Our results regarding the effectiveness of chiropractic care are consistent with previous reviews comparing chiropractors to other provider groups [ 21 , 22 ] and SMT to other treatment modalities [ 24 – 26 ]. All have concluded that there is no clear superiority for any provider group or modality.…”

The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

“…Previous systematic reviews reported inconsistent results on the effectiveness of manual therapy for the management of MSDs of the shoulder [ 16 – 21 ]. For the management of nonspecific shoulder pain, our conclusion that manipulation and mobilization may be effective agrees with two previous systematic reviews examining manipulation and mobilization [ 16 ] or mobilization [ 18 ]; however two other reviews reported inconclusive evidence for the effectiveness of mobilization [ 17 ] or manipulation [ 21 ]. Our conclusion that neck mobilization does not provide additional benefit to a multimodal program of care for the treatment of subacromial impingement syndrome does not agree with a previous systematic review which found inconclusive evidence for the effectiveness of mobilization [ 18 ].…”

“…For the management of nonspecific shoulder pain, our conclusion that manipulation and mobilization may be effective agrees with two previous systematic reviews examining manipulation and mobilization [ 16 ] or mobilization [ 18 ]; however two other reviews reported inconclusive evidence for the effectiveness of mobilization [ 17 ] or manipulation [ 21 ]. Our conclusion that neck mobilization does not provide additional benefit to a multimodal program of care for the treatment of subacromial impingement syndrome does not agree with a previous systematic review which found inconclusive evidence for the effectiveness of mobilization [ 18 ]. Moreover, our conclusions disagree with three reviews that reported that manipulation and mobilization [ 16 , 19 ] or manipulation [ 20 ] is effective for subacromial impingement syndrome.…”

Improved Chronic Low Back Pain, Radiographic Alignment, and Patient Reported Outcomes Following Postural Rehabilitation Protocols: A Case Series of Two Patients with 18- and 26-Months Follow-Up

“…Non-specific chiropractic SMT and general SMT increases ROM and improves pain briefly; however, no known studies have repeatable long-term improvement in subjective/objective outcome measures [ 26 ]. This result is consistent with our two patients who received general SMT from chiropractors prior to this intervention without long-term reduction in symptoms or disability [ 27 , 28 ].…”

Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies

“…Our results regarding the effectiveness of chiropractic care are consistent with previous reviews comparing chiropractors to other provider groups [ 21 , 22 ] and SMT to other treatment modalities [ 24 – 26 ]. All have concluded that there is no clear superiority for any provider group or modality.…”

The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

“…Previous systematic reviews reported inconsistent results on the effectiveness of manual therapy for the management of MSDs of the shoulder [ 16 – 21 ]. For the management of nonspecific shoulder pain, our conclusion that manipulation and mobilization may be effective agrees with two previous systematic reviews examining manipulation and mobilization [ 16 ] or mobilization [ 18 ]; however two other reviews reported inconclusive evidence for the effectiveness of mobilization [ 17 ] or manipulation [ 21 ]. Our conclusion that neck mobilization does not provide additional benefit to a multimodal program of care for the treatment of subacromial impingement syndrome does not agree with a previous systematic review which found inconclusive evidence for the effectiveness of mobilization [ 18 ].…”

“…For the management of nonspecific shoulder pain, our conclusion that manipulation and mobilization may be effective agrees with two previous systematic reviews examining manipulation and mobilization [ 16 ] or mobilization [ 18 ]; however two other reviews reported inconclusive evidence for the effectiveness of mobilization [ 17 ] or manipulation [ 21 ]. Our conclusion that neck mobilization does not provide additional benefit to a multimodal program of care for the treatment of subacromial impingement syndrome does not agree with a previous systematic review which found inconclusive evidence for the effectiveness of mobilization [ 18 ]. Moreover, our conclusions disagree with three reviews that reported that manipulation and mobilization [ 16 , 19 ] or manipulation [ 20 ] is effective for subacromial impingement syndrome.…”

Improved Chronic Low Back Pain, Radiographic Alignment, and Patient Reported Outcomes Following Postural Rehabilitation Protocols: A Case Series of Two Patients with 18- and 26-Months Follow-Up

“…Non-specific chiropractic SMT and general SMT increases ROM and improves pain briefly; however, no known studies have repeatable long-term improvement in subjective/objective outcome measures [ 26 ]. This result is consistent with our two patients who received general SMT from chiropractors prior to this intervention without long-term reduction in symptoms or disability [ 27 , 28 ].…”

Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies

“…Our results regarding the effectiveness of chiropractic care are consistent with previous reviews comparing chiropractors to other provider groups [ 21 , 22 ] and SMT to other treatment modalities [ 24 – 26 ]. All have concluded that there is no clear superiority for any provider group or modality.…”

The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

“…Previous systematic reviews reported inconsistent results on the effectiveness of manual therapy for the management of MSDs of the shoulder [ 16 – 21 ]. For the management of nonspecific shoulder pain, our conclusion that manipulation and mobilization may be effective agrees with two previous systematic reviews examining manipulation and mobilization [ 16 ] or mobilization [ 18 ]; however two other reviews reported inconclusive evidence for the effectiveness of mobilization [ 17 ] or manipulation [ 21 ]. Our conclusion that neck mobilization does not provide additional benefit to a multimodal program of care for the treatment of subacromial impingement syndrome does not agree with a previous systematic review which found inconclusive evidence for the effectiveness of mobilization [ 18 ].…”

“…For the management of nonspecific shoulder pain, our conclusion that manipulation and mobilization may be effective agrees with two previous systematic reviews examining manipulation and mobilization [ 16 ] or mobilization [ 18 ]; however two other reviews reported inconclusive evidence for the effectiveness of mobilization [ 17 ] or manipulation [ 21 ]. Our conclusion that neck mobilization does not provide additional benefit to a multimodal program of care for the treatment of subacromial impingement syndrome does not agree with a previous systematic review which found inconclusive evidence for the effectiveness of mobilization [ 18 ]. Moreover, our conclusions disagree with three reviews that reported that manipulation and mobilization [ 16 , 19 ] or manipulation [ 20 ] is effective for subacromial impingement syndrome.…”