Intervention Review ArticleEvidence-informed management of chronic low back pain with spinal manipulation and mobilization
Section snippets
Terminology
For the purpose of this review, spinal manipulative therapy (SMT) is defined as the application of high-velocity, low-amplitude manual thrusts to the spinal joints slightly beyond the passive range of joint motion [1]. Spinal mobilization (MOB) is defined as the application of manual force to the spinal joints within the passive range of joint motion that does not involve a thrust.
History
Although the practice of spinal manipulation is now frequently associated with chiropractic—which began as a
Mechanism of action
Many hypotheses related to the mechanism of action for SMT and MOB focus on the immediate consequences of applying external force to the tissues of the spine. It is thought that if target tissues are relatively rigid (eg, bone), the applied force may cause the tissue to displace, whereas if the target tissue is relatively nonrigid, the applied force may cause it to deform. Several studies related to SMT and MOB have examined the immediate effects of tissue displacement or deformation, including
Review methods
The purpose of this study was to assess the efficacy of SMT and MOB for the management of CLBP by updating a previous systematic review that included literature published through 2002 [3]. An updated literature search (through 2006) for RCTs evaluating the therapeutic efficacy of SMT or MOB for CLBP was performed using the same strategy [3]. Additionally, citation tracking of references in relevant publications was used, including the nonindexed chiropractic, osteopathic, physical therapy, and
Harms
SMT can be associated with relatively benign temporary side effects including mild localized soreness or pain, which typically does not interfere with activities of daily living [64]. A large, prospective observational study of 1,058 patients who received 4,712 sessions of SMT from 102 DCs in Norway reported the following common adverse events (AEs): local discomfort (53%), headache (12%), tiredness (11%), radiating discomfort (10%), and dizziness (5%) [65]. Most of these AEs occurred within 4
Summary
For CLBP, there is moderate evidence that SMT with strengthening exercise is similar in effect to prescription nonsteroidal anti-inflammatory drugs with exercise in both the short term and long term. There is also moderate evidence that flexion-distraction MOB is superior to exercise in the short term and superior/similar in the long term. There is moderate evidence that a regimen of high-dose SMT is superior to low-dose SMT in the very short term. There is limited to moderate evidence that SMT
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FDA approval status: not applicable.
Author GK acknowledges research funding: Federal/state agency.
Nothing of value received from a commercial entity related to this manuscript.