Science In Brief

Chiropractic Literature Review


The Study:   Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis                

The Facts:

1. Mobilization and manipulation are frequently used methods of care for chronic low back pain.

2. “However, questions remain about their efficacy, dosing, safety, and how these approaches compare with other therapies.”

3. This was a review of the literature.

4. 51 trials were included in this review.

5. The authors felt that there was moderate evidence to conclude that, when compared to exercise, manipulation “may produce small-moderate reduction in pain intensity” and that it is likely to reduce disability.

6. Manipulation’s effect appears to increase over periods of 3 to 6 months.

7. “There is moderate-quality evidence that mobilization (i.e. non-thrust) interventions are likely to have minimal effect compared with other active comparators.” (i.e. active forms of care such as exercise)

8. The authors felt that multimodal care might be promising.

Take Home:

It appears that compared to other active forms of care (i.e. exercise) manipulation appears to produce small to moderate reductions in pain and probably reduces disability.

Reviewer's Comments:

First this doesn’t sound bad. Manipulation is probably a little better than exercise for care of chronic low back pain. But I do have some thoughts. The authors didn’t say it was head and shoulders better. So how much is it worth to have a little better outcome. Perhaps a lot to some patients, but perhaps not so much to others and what about insurance companies and government regulators. It appears to me that someone is going to ask why society should pay for care involving manipulation when the outcomes are not a lot better than exercise when we consider the idea that exercises could be given to patients to use at home for very little cost. I’m pretty sure that regulators have already thought of that. So be careful about hanging your hat on just the idea that manipulation reduces pain and probably reduces disability. But if you include the thought that properly applied chiropractic care can also produce structural alignment and biomechanical functional improvements then when you put the whole picture together the case for chiropractic becomes much stronger. But we just have to make sure that structural alignment and biomechanical considerations are part of the chiropractic treatment care program. Don’t be a gravity denier, think structure. Now that’s a bumper sticker.

Reviewer: Roger Coleman DC

Editor: Mark R. Payne DC

Reference: Coulter ID, Crawford C, Hurwitz EL, Vernon H,Khorsan R, Suttorp Booth M, Herman PM. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J. 2018 May;18(5):866-879. doi: 10.1016/j.spinee.2018.01.013. Epub 2018 Jan 31.


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