To Your Health
September, 2020 (Vol. 14, Issue 09)
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Your Best Choice for Back Pain

By Editorial Staff

While research supports the value of spinal manipulation for chronic low back pain when performed by doctors of chiropractic, a new study published in JAMA Network Open suggests doctors of osteopathy and physical therapists may not enjoy the same success.

According to the randomized clinical trial involving 162 young adults (average age: 25 years) with chronic, mild to moderate LBP, both spinal manipulation and mobilization were no more effective than placebo in reducing low back pain and related disability. "Licensed clinicians (either a doctor of osteopathic medicine or physical therapist), with at least 3 years of clinical experience using manipulative therapies provided all treatments."

Participants were randomized into one of three groups and received six treatment sessions of spinal manipulation, spinal mobilization or placebo (sham cold laser) over the course of three weeks (two sessions per week for three weeks). Primary outcome measures assessed included 1) change in pain rating scale over the past seven days; and 2) change in disability questionnaire score 48-72 hours after completion of the six treatments.

good idea - Copyright – Stock Photo / Register Mark In their conclusion, the authors state: "Our findings indicated that spinal manipulation and spinal mobilization were no more effective than a well-chosen placebo in reducing pain and disability in patients with chronic low back pain. We conclude that these manipulative therapy techniques do not appear to be effective for chronic low back pain, at least among relatively young individuals with mild to moderate back pain."

Interesting ... but what if the treating clinicians had been doctors of chiropractic?  Here are just a few of the studies supporting chiropractic spinal manipulation for chronic LBP:

  • Giles LG, et al. Spine, 2003 Jul 15;28(14):1490-502.
  • Senna MK, et al. Spine, 2011 Aug 15;36(18):1427-1437.
  • Muller R, et al. JMPT, 2005;28(1)3-11.

"Many consumers and even some medical professionals still assume that spinal manipulation is equally effective regardless of the provider type," said Sherry McAllister, DC, executive vice president of the Foundation for Chiropractic Progress, in a press release reporting on the study. "These findings, when taken along with the findings of previous papers, help to differentiate the effectiveness of spinal manipulation for low back pain delivered in the context of chiropractic care. This helps explain why historically 94% of spinal manipulation is provided by doctors of chiropractic. This study also brings into question the effectiveness of mobilization of the spine for low back pain as provided by physical therapists and osteopaths."