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
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.
Summary- Low Back Pain Treatment
(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 (diathermy)
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 back pain.
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 weeks.
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 leg raise.
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 follow up.
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 stimulation.
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 class.
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 scores.
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 improvement.
Mead and associates observed
that chiropractic treatment was more effective than hospital outpatient
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
Summary of Conclusions:
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, B,C.)
- 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,
We 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.