A large and growing body of scientific evidence has accumulated regarding the treatment of musculoskeletal problems, spine and joint pain.
In 2007 the medical journal, Annals of Internal Medicine recommended:
The only recommendation for acute back pain unresponsive to self-care was to “consider the addition of drug therapy with proven benefits—for acute low back pain, spinal manipulation”
For chronic low back pain, the study recommended the following options: intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, and spinal manipulation
Ann Intern Med. 2007;147:478-491.
It can no longer be said that there is a lack of scientific evidence supporting the effectiveness of chiropractic care, or any medical opposition to the use of spinal manipulation.
Simply stated, there is ample scientific evidence to support the notion that chiropractic care should be the standard treatment of choice for such things as acute and chronic low back pain. In today’s healthcare world where “Evidence Based Healthcare” is becoming more popular, chiropractic care is more than holding its own in the scientific research arena. In fact, a strong case can be made that the curricula of all of our country’s medical schools should be amended to include training of tomorrow’s Medical Doctors to refer patients with some to doctors of chiropractic for care. This protocol is already under way in many of our military and Veteran’s hospitals, where economic and political bias is less influential.
When it comes to science, this is the most exciting time in the history of chiropractic!
Below is a short summary of a few additional recent studies that have been published in high quality medical and scientific journals.
Evidence Summary- Low Back Pain Treatment
(887 source documents used for this review, including 70 RCTs, 12 guidelines, 14 systematic reviews/meta analyses, 11 cohort studies.)
Review of 16 trials on mixed acute and chronic low back pain- “HVLA (manipulation) is equal to medical management” in management of pain and disability relating to low back pain.
Patients treated for acute low back pain: 94% of those given manipulation were symptom free in 14 days compared to 25% receiving physical therapy modality (diathermy)
Patients receiving manipulation vs. sham benefited from the manipulation, both in terms of recovery and speed of recovery. Improvement was better for those greater prolonged illness.
Manipulation is superior to mobilization for acute low back pain.
Two different chiropractic techniques were compared and found to be equally effective in treating low back pain.
In a study comparing management of acute low back pain with medication versus manipulation, 50% of those receiving manipulation were symptom-free within 1 week and 87% were discharged symptom free in 3 weeks, while only 27% of the control group (bed rest and analgesics) were symptom-free in 1 week and 60% in 3 weeks.
In a study comparing manipulation to steroid injections and to a control group receiving conventional activating therapy, after 4 months the manipulation group suffered from less restricted motion in extension, less restriction in side-bending to both sides, less local pain on extension and right side-bending, less radiating pain and less pain while performing a straight leg raise.
Comparing chiropractic care with conventional medical care for low back pain, results were similar after one month, but more notable improvements in the chiropractic group was noted at both 3 and 6 month follow up.
Manual therapy, when combined with “staying active management” of sub acute low back pain patients, produced better results than the use of “staying active management”.
Manipulation offered better pain improvement than did transcutaneous electrical nerve stimulation.
Exercise : A Danish systematic review (Bronfort, Jacobsen, et al. 2004 4128id) examined twelve international sets of guidelines , twelve systematic reviews and ten randomized clinical trials on exercise. Results suggested that exercise, in general, benefits patients with sub acute back pain. No clear superior method is known. Use of a basic program that can be readily modified to meet individual patient needs is recommended. Issues of strength, endurance, stabilization, and coordination without excessive loading can all be addressed without the use of high tech equipment. Intensive training consisting of greater than 30 and less than 100 hours of training are most effective.
Lewis, et. al. (Lewis, Hewitt, et.al. 2005 4140 id) found improvement occurred when patients treated by combined manipulation and spinal stabilization exercises versus that seen through a 10-station exercise class.
When comparing chiropractic manipulation to placebo/sham for sub acute low back pain chiropractic manipulation scored better than placebo in reducing pain and Global Impression of Severity scores. In the same study chiropractic manipulation was more effective than muscle relaxants in reducing Global Impression of Severity scores.
Comparing manual therapy to exercise in patients with chronic low back pain who were sick listed, while both groups showed improvements in pain intensity, functional disability, general health and return to work, the manual therapy group showed significantly greater improvements than did the exercise group for all outcomes. Results were consistent for both short and long term.
The combined intervention of manipulation, stabilization exercise and physician consultation was more effective than consultation alone.
Comparison of a combination of manipulation and physical therapy with general treatment by a general practitioner demonstrated more rapid improvement in physical function capacity and pain improvement.
Mead and associates observed that chiropractic treatment was more effective than hospital outpatient care.
Spinal manipulation led to better long and short term disability reduction compared to physical therapy or home exercise.
Coxhead reported that manipulation provided better outcomes when compared to either exercise, corsets, traction or no exercises when studied in the short term. Manipulation was demonstrated to effectively manage low back pain accompanied by radiating leg pain.
Actual spinal manipulation produced significantly better results in terms of short term pain and disability relief than sham manipulation.
Higher rates of care were demonstrated to be more effective in managing chronic low back pain.
Disc herniation: manipulation has been demonstrated to lead to greater short-term improvement in pain and disability than does chemonucleolysis for managing disc herniation.
Manipulation was reported to be superior to conventional therapy in treating subjects suffering from a diagnosis of prolapsed inter-vertebral discs.
Manipulation was found to be as effective as lumbar flexion exercises and home care.
Spinal manipulation combined with exercise is as effective as the combination of NSAIDS and exercise for low back pain.
Multiple high quality studies have demonstrated that patient confidence and patient satisfaction levels are higher with care provided by practitioners who utilize manual therapy.
Summary of Conclusions: