[Spinal manipulation therapy in low back pain : Why? When? Where? How?]

Area of Science:

• Evidence-based medicine
• Manual medicine
• Musculoskeletal disorders

Background:

• Low back pain (LBP) management requires an evidence-based approach.
• Understanding mechanisms, indications, efficacy, and safety is crucial.
• Differentiating LBP entities guides treatment strategies.

Purpose of the Study:

• To present an evidence-based overview of manipulation and mobilization (MM) for low back pain.
• To detail the mechanisms, indications, efficacy, cost-effectiveness, user criteria, and adverse effects of MM.
• To reframe LBP classification using "entities" rather than "specific" or "non-specific".

Main Methods:

• Systematic review of existing literature on MM for LBP.
• Analysis of evidence regarding efficacy, safety, and cost-effectiveness.
• Evaluation of user criteria and adverse event profiles.

Main Results:

• MM demonstrates efficacy in pain relief, functional recovery, and relapse prevention for acute and chronic LBP.
• MM is as effective as other therapies but carries a lower risk profile.
• MM can be used as standalone treatment for acute LBP or as part of multimodal therapy for chronic LBP.
• MM application requires specialized training and adherence to Good Clinical Practice.

Conclusions:

• Manual mobilization is a safe and effective treatment for low back pain.
• MM offers significant benefits for pain and function with minimal risk.
• Proper training and adherence to guidelines ensure the safe application of MM for low back pain.