Effectiveness of Manipulation

Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH.  Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals Internal Medicine 2012 Jan 3;156(1 Pt 1):1-10.

For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of home exercise with advice resulted in similar outcomes at most time points.

Bishop PB, Quon JA, Fisher CG, Dvorak MF.The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. The Spine Journal. 2010 Dec;10(12):1055-64.

A randomized controlled trial looking at the effectiveness of treatments for acute mechanical low back pain. This study compared chiropractors using evidence-based clinical guidelines including spinal manipulation vs. family physician directed usual care (medication, PT, massage). Significantly greater improvements were seen in condition specific function with chiropractors using evidence-based guidelines compared to family physician usual care. 

Giles, G.F., Reinhold, M. Long Term Follow-Up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture and Spinal Manipulation for Chronic Pain Syndromes. Journal of Manipulative and Physiological Therapeutics. 2005 Jan;28 (1):3-11. 

Patients receiving manipulation were shown to have significantly better outcomes in the long term compared to those patients receiving medication(Celebrex, Vioxx or Acetominophen) or acupuncture.

McMorland, G., Suter, E, Casha, S., du Plessis, S., Hurlbert, RJ. Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Clinical Trial. Journal of Manipulative and Physiological Therapeutics. 2010 (Oct); 33 (8): 576–584

Sixty percent of patients with sciatica who had failed other medical management (analgesics, PT, massage) benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of the 40% left unsatisfied, subsequent surgical intervention confers excellent outcome.

Cifuentes M, Willetts J, Wasiak R. Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of  Occupational and Environmental Medicine. 2011 Apr;53(4):396-404.

In work-related nonspecific LBP, the use of health maintenance care provided by a chiropractor was associated with lower disability reoccurance then with physical therapist or physician services.


The strength/quality of the evidence regarding effectiveness is graded according to an adapted version of the latest grading system developed by the US Preventive Services Task Force (USPSTF) and a study risk bias assessment tool for the RCT's (http://www.ahrq.gov/clinic/uspstf/grades.htm).

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