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Spinal manipulative therapy for chronic low-back pain.

Sidney M Rubinstein1, Marienke van Middelkoop, Willem Jj Assendelft

  • 1Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, PO Box 7057, Room D518, Amsterdam, Netherlands, 1007 MB.

The Cochrane Database of Systematic Reviews
|February 18, 2011
PubMed
Summary

Spinal manipulative therapy (SMT) offers a small, short-term improvement in pain and function for chronic low-back pain, but it is not clinically significant compared to other treatments. More research is needed on its long-term effects and cost-effectiveness.

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Area of Science:

  • Evidence-based practice
  • Musculoskeletal disorders
  • Pain management

Background:

  • Chronic low-back pain is a prevalent condition with numerous treatment options.
  • Spinal manipulative therapy (SMT) is a widely practiced intervention for low-back pain globally.

Purpose of the Study:

  • To systematically assess the effectiveness of SMT for individuals experiencing chronic low-back pain.
  • To evaluate the impact of SMT on pain, functional status, recovery, return-to-work, and quality of life.

Main Methods:

  • A comprehensive literature search was conducted for randomized controlled trials (RCTs) up to June 2009 across multiple databases.
  • RCTs involving adults with chronic low-back pain, excluding sciatica-exclusive studies, were included. Primary outcomes were pain and functional status.

Main Results:

  • High-quality evidence indicates SMT provides a small, statistically significant but not clinically relevant, short-term benefit for pain relief and function compared to other interventions.
  • Evidence quality varies for SMT as an adjunct therapy, and is very low for comparisons against inert or sham SMT.
  • Data on recovery, return-to-work, quality of life, and costs remain limited; no serious complications were reported.

Conclusions:

  • High-quality evidence suggests SMT does not offer a clinically relevant advantage over other interventions for chronic low-back pain.
  • Further research prioritizing cost-effectiveness and long-term outcomes, particularly compared to inert or sham treatments, is recommended.