+AA
Fr
Back
Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

In adults with acute low back pain, spinal manipulation improves pain and function by a small amount in the short term

Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA. 2017;317:1451-60.

Review questions

In adults with acute low back pain (pain lasting for 6 weeks or less), does spinal manipulative therapy (spinal manipulation) reduce pain or improve functioning more than other therapies? What are the harms?

Background

Most people will have low back pain at some point in their lives. Anyone can get low back pain although it is more common as you get older. The cause of low back pain is often unknown.

There are many treatments for acute low back pain. These include pain-relieving and muscle-relaxing drugs, heat, exercise, physical therapy, and spinal manipulation. Spinal manipulation involves hands-on therapies, including chiropractic therapy. This review assessed how well spinal manipulation works compared with other therapies.

How the review was done

The researchers did a systematic review of studies available up to February 2017.

They found 26 randomized controlled trials with 2,908 people who had an average age of 26 to 44 years.

The key features of the studies were:

  • people were adults with low back pain lasting for 6 weeks or less;
  • treatment was spinal manipulation alone or with other therapies, including chiropractic care;
  • spinal manipulation was done by physical therapists, chiropractors, medical doctors, or osteopaths;
  • spinal manipulation was compared with different therapies (mainly pain-relieving drugs, exercise, physical therapy, or usual care) or sham therapy (placebo); and
  • people were followed for up to 6 weeks.

Studies done only in people with sciatica or those in hospital were excluded.

What the researchers found

Compared with another therapy, spinal manipulation:

  • improved pain by a small amount for up to 6 weeks; and
  • improved function by a small amount at 3 to 6 weeks.

The effects of spinal manipulation were quite different (heterogeneous) across trials.

Few trials compared spinal manipulation with sham therapy.

There wasn’t much information reported about the adverse effects of spinal manipulation compared with other therapies.

 

Conclusion

In adults with acute low back pain, spinal manipulative therapy improves pain and functioning by a small amount in the short term.

Spinal manipulative therapy (SMT) vs another therapy in adults with acute low back pain

Outcomes

Follow-up period

Number of trials (number of people)

Absolute effects of SMT

Pain

2 weeks or less

9 trials (663 people)*

On average, SMT reduced pain scores by about 10 points out of 100, although results varied  across the trials*.

 

3 to 6 weeks

10 trials (1142 people)

On average, SMT reduced pain scores by about 10 points out of 100, although results varied across trials.

Functioning

2 weeks or less

7 trials (491 people)*

No difference between SMT and other therapies.

 

3 to 6 weeks

6 trials (762 people)

On average, SMT improved functioning by a small amount, although results varied across trials.

*Additional information was obtained from a more detailed report of this trial: Shekelle PG, Paige NM, Miake-Lye IM, et al. The effectiveness and harms of spinal manipulative therapy for the treatment of acute neck and lower back pain: A systematic review. Washington, DC: US Department of Veterans Affairs: 2017 Apr.



Related Topics


Glossary

Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Several non-invasive treatments work for neck pain

    Institute for Work & Health
    Educational videos, exercise, and neck mobilization were more beneficial for treating neck pain or whip lash than ultrasound or electrical stimulation. Laser therapy, exercise and massage or acupuncture may help with chronic pain. Hard or soft collars did not work.
  • Some herbal drugs may ease back pain in short term

    Institute for Work & Health
    Some alternative herbal medicines may help to relieve back pain. Devil's Claw, Willow Bark and cayenne may help reduce pain in the short term. However, there is no evidence that these substances are safe or useful in the long-term.
  • Exercise for low back pain

    Berkeley Wellness
    Exercise can help prevent lower back pain, especially when combined with education about back care.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Register
Want the latest in aging research? Sign up for our email alerts.
Subscribe

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use