Does Science Say?
During the past decade, a large and
growing body of scientific evidence has accumulated about
how people with musculoskeletal problems, back pain, neck
pain, etc, should be treated. It can no longer be said
that there is a lack of scientific evidence supporting the
effectiveness of chiropractic care.
Simply stated, there is ample scientific
evidence to support the notion that chiropractic care
should be the standard treatment of choice for such things
as acute and chronic low back pain. In today’s
healthcare world where “Evidence Based Healthcare” is
becoming more popular, chiropractic care is more than
holding its own in the scientific research arena. In fact,
a strong case can be made that the curricula of all of our
country’s medical schools should be amended to include
training of tomorrow’s Medical Doctors to refer patients
with some to doctors of chiropractic for care. This
protocol is already under way in many of our military and
Veteran’s hospitals, where economic and political bias
is less influential.
When it comes to science, this is the most
exciting time in the history of chiropractic!
Below is a short summary of a few of the
recent studies that have been published in high quality
medical and scientific journals.
Evidence Summary- Low Back Pain
(887 source documents used for this review,
including 70 RCT's, 12 guidelines, 14 systematic
reviews/meta analyses, 11 cohort studies.)
Review of 16 trials on mixed acute and
chronic low back pain- “HVLA (manipulation) is equal to
medical management” in management of pain and disability
relating to low back pain.
Patients treated for acute low back pain:
94% of those given manipulation were symptom free in 14
days compared to 25% receiving physical therapy modality
Patients receiving manipulation vs. sham
benefited from the manipulation, both in terms of recovery
and speed of recovery. Improvement was better for those
greater prolonged illness.
Manipulation is superior to mobilization
for acute low back pain.
Two different chiropractic techniques were
compared and found to be equally effective in treating low
In a study comparing management of acute
low back pain with medication versus manipulation, 50% of
those receiving manipulation were symptom-free within 1
week and 87% were discharged symptom free in 3 weeks,
while only 27% of the control group (bed rest and
analgesics) were symptom-free in 1 week and 60% in 3
In a study comparing manipulation to
steroid injections and to a control group receiving
conventional activating therapy, after 4 months the
manipulation group suffered from less restricted motion in
extension, less restriction in side-bending to both sides,
less local pain on extension and right side-bending, less
radiating pain and less pain while performing a straight
Comparing chiropractic care with
conventional medical care for low back pain, results were
similar after one month, but more notable improvements in
the chiropractic group was noted at both 3 and 6 month
Manual therapy, when combined with
“staying active management” of sub acute low back pain
patients, produced better results than the use of
“staying active management”.
Manipulation offered better pain
improvement than did transcutaneous electrical nerve
Exercise : A Danish systematic review (Bronfort,
Jacobsen, et al. 2004 4128id) examined twelve
international sets of guidelines , twelve systematic
reviews and ten randomized clinical trials on exercise.
Results suggested that exercise, in general, benefits
patients with sub acute back pain. No clear superior
method is known. Use of a basic program that can be
readily modified to meet individual patient needs is
recommended. Issues of strength, endurance, stabilization,
and coordination without excessive loading can all be
addressed without the use of high tech equipment.
Intensive training consisting of greater than 30 and less
than 100 hours of training are most effective.
Lewis, et. al. (Lewis, Hewitt, et.al. 2005
4140 id) found improvement occurred when patients treated
by combined manipulation and spinal stabilization
exercises versus that seen through a 10-station exercise
When comparing chiropractic manipulation
to placebo/sham for sub acute low back pain chiropractic
manipulation scored better than placebo in reducing pain
and Global Impression of Severity scores. In the same
study chiropractic manipulation was more effective than
muscle relaxants in reducing Global Impression of Severity
Comparing manual therapy to exercise in
patients with chronic low back pain who were sick listed,
while both groups showed improvements in pain intensity,
functional disability, general health and return to work,
the manual therapy group showed significantly greater
improvements than did the exercise group for all outcomes.
Results were consistent for both short and long term.
The combined intervention of manipulation,
stabilization exercise and physician consultation was more
effective than consultation alone.
Comparison of a combination of
manipulation and physical therapy with general treatment
by a general practitioner demonstrated more rapid
improvement in physical function capacity and pain
Mead and associates observed that
chiropractic treatment was more effective than hospital
Spinal manipulation led to better long and
short term disability reduction compared to physical
therapy or home exercise.
Coxhead reported that manipulation
provided better outcomes when compared to either exercise,
corsets, traction or no exercises when studied in the
short term. Manipulation was demonstrated to effectively
manage low back pain accompanied by radiating leg pain.
Actual spinal manipulation produced
significantly better results in terms of short term pain
and disability relief than sham manipulation.
Higher rates of care were demonstrated to
be more effective in managing chronic low back pain.
Disc herniation: manipulation has been
demonstrated to lead to greater short-term improvement in
pain and disability than does chemonucleolysis for
managing disc herniation.
Manipulation was reported to be superior
to conventional therapy in treating subjects suffering
from a diagnosis of prolapsed inter-vertebral discs.
Manipulation was found to be as effective
as lumbar flexion exercises and home care.
Spinal manipulation combined with exercise
is as effective as the combination of NSAIDS and exercise
for low back pain.
Multiple high quality studies have
demonstrated that patient confidence and patient
satisfaction levels are higher with care provided by
practitioners who utilize manual therapy.
As much or more evidence exists for the use of spinal
manipulation to reduce symptoms and improve function
in patients with chronic low back pain as for use in
acute and sub-acute low back pain. (Evidence grade: A)
- Use of exercise in conjunction with manipulation
is likely to speed and improve outcomes as well as
minimize episodic recurrence. (Evidence grade: A,
- There is less evidence for the use of
manipulation for patients with low back pain
accompanied by radiating leg pain, sciatica, and
radiculopathy. (Evidence grade: A,B)
- Cases with high severity of symptoms may benefit
by referral for co-management of symptoms with
medication. (Evidence grade: B)
will be happy to provide you with any of the references
for these studies. Please call (928) 771-9400 or click here
to send an e-mail request for references.