Why Is There Debate of This Low-Cost Therapy?

Spinal manipulation therapy for acute low back pain is very popular

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) A visit to the chiropractor for an adjustment can bring a sense of relief to some patients. Other back pain sufferers believe such practices deliver no value. This has left many wondering - is it effective or not?

A recent study examined the effects of spinal manipulation therapy (SMT) for short term, or acute, back pain. This therapy was found to be no more effective than other therapies.

While this study finds SMT ineffective for acute back pain, it is important to note that the styles of SMT and the levels and types of pain the study evaluated varied greatly. While spinal manipulation may not be appropriate for all situations, it may work for some.

"See a health professional for back pain solutions."

Sidney M. Robinstein of VU Medical Center in Amsterdam, Netherlands and colleagues reviewed 20 existing randomized controlled trials with a total of 2,674 participants. The participants received either spinal manipulation or mobilization of the spine for low back pain lasting less than six weeks.

Most commonly, the SMT was administered by a physiotherapist or chiropractor. Some participants received SMT from an ortheopathic physician, a combination physiotherapist or medical manipulator or an osteopath.

SMT is any hands-on treatment that includes manipulation or mobilization of the spine.

Mobilizations are slow passive movements made within a joint's range of motion. Manipulations usually use fast thrusts applied to a synovial joint and often result in a crack or pop.

The therapy is thought to work by alleviating pressure or mechanical stress within the skeletal body and by impacting the neurons that process pain.

In most cases in this study, manipulation was used.

This review looked for outcomes of pain relief, ability to function, recovery rates and length of time to return to work.

The study authors concluded that SMT was no more effective than exercise, drugs like aspirin and ibuprofen, or physiotherapy.

The authors also concluded that the therapy was no more effective than ultrasounds or heat therapy, interventions that are known to be ineffective.

However, not all practitioners deliver SMT in the same way so it is difficult to compare one practitioner's method to another.

Some forms of manipulation are aggressive while others focus more on stretching. Also, every injury and person is unique and responds differently to these treatments, both mentally and physically.

"The patients' level of motivation and mental health can play a role in their progress," said Diane Shiao, PT, MSPT, DPT of Revive Physical Therapy and Wellness in Edison, New Jersey.

Dr. Shiao recommends a multidimensional approach to managing low back pain. SMT may work best when combined with other treatments.

“With the proper education of the patho-physiology and expected course of treatment, daily exercise, postural correction, and physical therapy which may include hands on procedures such as spinal mobilization, patients tend to respond better in reducing their pain levels and increasing their functional activities,” said Dr. Shiao.

The study was published in the Cochrane Library.

One of the study authors is coordinating editor of the Cochrane Back Review Group. Dr. Rubinstein is a chiropractor and uses SMT in his clinical practice.

Reviewed by: 
Review Date: 
November 5, 2012
Last Updated:
April 29, 2013