According to a report from the Cochrane Collaboration, spinal manipulative therapy as a treatment for chronic low-back pain may be no better or worse in relieving pain and improving function than a variety of other interventions, such as exercise, standard medical care, or physiotherapy.
The meta-analysis of 26 randomized controlled trials comprises data on a total of 6,070 participants and included cases of low-back pain that lasted longer than 12 weeks and weren't caused by a known medical condition, such as infection, tumor, or fracture. Studies that focused exclusively on sciatica were excluded.
For the purposes of the study, spinal manipulation therapy was defined as any hands-on treatment of the spine, including manipulation (high velocity thrust applied to a synovial joint) and mobilization (passive movement within the patient's range of motion and control). The treatment's effects on pain, functional status, and perceived recovery were the primary outcomes; secondary outcomes were quality of life and whether patients returned to work.
According to the authors, there's high-quality evidence that in comparison with other interventions, spinal manipulation therapy has "a small, statistically significant but not clinically relevant, short-term effect on pain relief . . . and functional status." Also, there's evidence (of varying quality, ranging from low to high) that spinal manipulation therapy has a significant short-term effect on pain relief and functional status when used in combination with other interventions.
The authors' recommendations for future research included evaluation of spinal manipulation therapy as an adjunct treatment, and they stressed the "dire need" for cost-effectiveness studies.-James M. Stubenrauch
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