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Related Experiment Videos

Spinal manipulative therapy for low back pain.

W J J Assendelft1, S C Morton, Emily I Yu

  • 1Department of Guideline Development and Research Policy, Dutch College of General Practioners, P.O. Box 3231, Utrecht, Netherlands.

The Cochrane Database of Systematic Reviews
|February 20, 2004
PubMed
Summary
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Spinal manipulative therapy (SMT) is not more effective than other standard treatments for low-back pain. This systematic review found no significant advantages for SMT in acute or chronic cases compared to common therapies.

Area of Science:

  • Orthopedics
  • Pain Management
  • Evidence-Based Medicine

Background:

  • Low-back pain represents a significant health burden and economic cost.
  • Spinal manipulative therapy (SMT) is a frequently recommended treatment for low-back pain.
  • Previous systematic reviews have yielded conflicting conclusions regarding SMT's effectiveness.

Purpose of the Study:

  • To reconcile discrepancies in existing research on SMT for low-back pain.
  • To provide updated effectiveness estimates by comparing SMT with other therapies.
  • To incorporate recent high-quality randomized controlled trials (RCTs) into the analysis.

Main Methods:

  • Conducted a comprehensive electronic search of major databases (Cochrane, MEDLINE, EMBASE, CINAHL) up to January 2000.

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  • Included RCTs evaluating SMT for low-back pain with at least one day of follow-up and clinically relevant outcomes.
  • Data extraction and meta-analysis were performed independently by two reviewers, comparing SMT against seven categories of interventions.

    • Main Results:

    • Thirty-nine RCTs were analyzed, with meta-regression models for acute/chronic and short/long-term outcomes.
    • For acute low-back pain, SMT showed superiority only over sham therapy or ineffective treatments.
    • SMT demonstrated no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school for acute or chronic pain.

    Conclusions:

    • Current evidence does not support the superiority of spinal manipulative therapy over other standard treatments for low-back pain.
    • The effectiveness of SMT is comparable to conventional care, including analgesics and physical therapy.
    • No specific factors like pain radiation, study quality, or manipulator's profession altered these findings.