Meta-Analysis: Spinal Manipulation Offers Modest Benefits for Acute Low Back Pain

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Spinal manipulation improves pain and function in adults with acute low back pain, although the effects are “clinically modest,” according to the authors of a JAMA meta-analysis.

The analysis included 26 randomized controlled trials comparing spinal manipulation with sham or alternative treatments (e.g., physical therapy) in adults with low back pain lasting 6 weeks or less. Spinal manipulation was provided by physical therapists, chiropractors, medical doctors, or osteopathic physicians.

Overall, moderate-quality evidence showed that spinal manipulation led to statistically significant but modest improvements in pain and function at up to 6 weeks, relative to the comparator group. However, heterogeneity across the trials was large in terms of manipulation type, patient selection, and results.

The authors and an editorialist note that spinal manipulation’s effect on pain was similar to that provided by nonsteroidal anti-inflammatory drugs. The editorialist concludes that spinal manipulation “may be an appropriate choice for some patients with uncomplicated acute low back pain.”