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Biomechanical Changes Related to Low Back Pain: An Innovative Tool for Movement Pattern Assessment and Treatment Evaluation in Rehabilitation
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Published on: December 13, 2024

Spinal manipulative therapy for acute low-back pain.

Sidney M Rubinstein1, Caroline B Terwee, Willem J J Assendelft

  • 1Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center,Amsterdam, Netherlands. sm.rubinstein@vumc.nl.

The Cochrane Database of Systematic Reviews
|September 14, 2012
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Spinal manipulative therapy (SMT) shows no significant advantage over inert treatments, sham SMT, or as an add-on therapy for acute low-back pain. Specific SMT techniques may offer short-term benefits for pain and function.

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Area of Science:

  • Orthopedics
  • Physical Medicine
  • Evidence-Based Practice

Background:

  • Low-back pain is a common condition with numerous treatment options.
  • Spinal manipulative therapy (SMT) is a widely practiced intervention for low-back pain.
  • This review updates previous analyses of SMT for acute low-back pain.

Purpose of the Study:

  • To evaluate the effectiveness of SMT for acute low-back pain (pain duration < 6 weeks).
  • To compare SMT against various control and active interventions.
  • To assess outcomes including pain, functional status, and recovery.

Main Methods:

  • A systematic search of multiple databases was conducted up to March 2011.
  • Included were randomized controlled trials (RCTs) of SMT in adults with acute low-back pain.
  • Primary outcomes were pain and function; secondary outcomes included return-to-work and quality of life.

Main Results:

  • Low to very low quality evidence suggests SMT is not more effective than inert interventions, sham SMT, or as an adjunct therapy.
  • Some low-quality evidence indicates short-term benefits for pain relief and function with SMT compared to inert interventions or as an add-on.
  • Specific SMT techniques (side-lying, supine thrust) showed short-term advantages over non-thrust techniques for pain, function, and recovery.

Conclusions:

  • SMT is not demonstrably more effective than sham, inert, or other interventions for acute low-back pain.
  • The evidence base is limited by the small number of studies and varying quality.
  • Clinical decisions regarding SMT should consider cost, patient/provider preference, and comparative safety.