Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back PainSystematic Review and Meta-analysis

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Back pain is among the most common symptoms prompting patients to seek care. Lifetime prevalence estimates of low back pain exceed 50%.1

Many treatments are used for acute back pain. None of the therapies for acute back pain has been established as superior to others. Treatments include analgesics, muscle relaxants, exercises, physical therapy modalities, heat, spinal manipulative therapy (SMT), and others.2

There have been multiple systematic reviews on spinal manipulation. A 2003 review concluded SMT was associated with statistically significant benefits compared with a sham manipulation, but not compared with other effective treatments for acute low back pain.3 Since then, the most recent Cochrane review on the subject concluded that SMT was not associated with statistically significant benefits compared with other interventions or sham SMT,4 but another Cochrane review of “combined chiropractic interventions” (which included SMT as part of the intervention) concluded the opposite.5 A third review assessed SMT for patients with back pain of less than 3 months duration and concluded it was associated with benefits compared with placebo treatment, no treatments, or massage,6 and a fourth review concluded “the efficacy of manipulation for patients with acute or chronic low back pain remains unconvincing.”7

As new trials continue to be published,813 and given these differences in conclusions among studies, this review was conducted to provide updated estimates of the effectiveness and harms associated with spinal manipulation compared with other nonmanipulative therapies for adults with acute low back pain.

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