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Spinal Manipulation for Acute (Short-term) Low Back Pain

Complementary and Alternative Therapies Evidence-based Summary


Date of review: March 2004

Acute low back pain is a sharp or widespread pain in the lower back (often accompanied by a lack of flexibility in the back) that lasts for less than three months. Spinal manipulation involves the stretching, mobilising or manipulation of the spine, surrounding tissues and other joints in order to relieve back pain and improve mobility. This evidence summary is based on database searches of chiropractic literature. A total of ten systematic reviews published since 1992, and 213 clinical trials on the use of spinal manipulation for acute low back pain were identified.

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Results summary


One recent systematic review summarized data from 38 clinical trials (involving about 5,000 people), and found that spinal manipulation can be beneficial for acute low back pain in the first 4-6 weeks. This review studied spinal manipulation delivered by a wide variety of health practitioners, including chiropractors. Results from the nine other systematic reviews (that included an additional 175 trials) were broadly consistent with these findings. Mild but reversible side effects (such as muscle and joint soreness) are reported by about 50% of people receiving spinal manipulation. Serious side effects can also occur (such as stroke or death), but are extremely rare.


Background


Acute low back pain


Acute low back pain is a common condition that presents as sharp or widespread pain in the lower back, and is often accompanied by a lack of flexibility and tenderness in the lower back. This condition is defined by activity intolerance due to lower back or leg symptoms (sciatica) lasting less than three months1. Back pain mainly affects adults of working age, particularly people aged between 40 and 60 years. Approximately 60-80% of the population will have experienced back pain at some point in time2. Back pain is sometimes referred to as mechanical back pain, idiopathic back pain, non-specific back pain, backache, or lumbago3. The main goal in treating acute low back pain is to decrease pain levels and allow people with the condition to resume their normal activities4.

Spinal manipulation


Spinal manipulation involves a range of manual (hands-on) manoeuvres that stretch, mobilise or manipulate the spine, surrounding tissues and other joints in order to relieve spinal pain and improve mobility5. Treatment sometimes involves a high velocity thrust, a technique in which the joints are adjusted rapidly5. Often these thrusts are accompanied by popping or snapping sounds5. The technique results in the brief stretching of joint capsules and is believed to reset the position of the spinal chord and nerves, allowing the nervous system to function at its best6. Forms of spinal manipulation are practised by chiropractors, osteopaths, physiotherapists, and medical practitioners7. To practice as a chiropractor in New Zealand, a person must have an accepted qualification, hold a valid annual practicing certificate and be registered with the New Zealand Chiropractic Board8. This board administers the Chiropractic Act (1982), which provides for the registration and discipline of registered chiropractors in New Zealand8. Osteopathy is not currently regulated by statute in New Zealand, however, osteopaths who belong to the New Zealand Register of Osteopaths Incorporated are able to provide subsidised ACC treatment9. To practice as a physiotherapist in New Zealand, a person must have an accepted qualification, hold a valid annual practicing certificate and be registered with the Physiotherapy Board of New Zealand10. This board administers the Physiotherapy Act 1949, which provides for the registration and discipline of registered physiotherapists in New Zealand10. To practice as a medical practitioner in New Zealand, a doctor must have an accepted qualification, hold a valid annual practicing certificate and must be registered with the Medical Council of New Zealand11. This council and a separate Medical Practitioners Disciplinary Tribunal administer the Medical Practitioners Act 199511.

Chiropractic


Chiropractic is a profession which specialises in the diagnosis, treatment and overall management of conditions which are due to mechanical dysfunction of the joints, (particularly those of the spine) and their effects on the nervous system5. Chiropractic specialises in manual therapy, especially spinal manipulation. Treatment consists of a wide range of manipulative techniques designed to improve the function of joints, thereby relieving pain and muscle spasm. Manipulation is very specific and directed at individual joints in order to reduce strains and improve mobility in one area without upsetting another5.

Osteopathy


Osteopathy is an established system of diagnosis and treatment that places its main emphasis on the structural and functional integrity of the body12. The main focus of most osteopaths is the musculoskeletal system muscles, bones and joints, in that they are considered vital to the healthy functioning of the body as a whole12. Osteopathy is based on a set of unique biomechanical principles13. Treatment can consist of a wide range of manual therapies/techniques such as: massage and stretching, articulation techniques (passively moving joints through there range of motion), muscle energy techniques, counterstrain and functional techniques, manipulation, visceral techniques (used in the management of conditions affecting internal organs) and cranial osteopathy13.

Physiotherapy


Physiotherapy is a profession concerned with maximizing mobility and quality of life14. It uses physical approaches to promote, maintain and restore physical, psychological and social wellbeing, taking account of variations in health status15. Physiotherapy extends from health promotion to: injury prevention, acute care, rehabilitation, maintenance of functional mobility, maintenance of the best achievable health in people with chronic illness, patient and carer education, and occupational health15. Treatment can consist of exercises to improve strength and fitness, massage, mobilization and manipulative techniques, use of electrotheraputic apparatus (such as ultrasound) to promote healing, and pool exercises16.


Evidence reviewed in this summary


Efficacy information


  • Systematic reviews: This evidence summary identified ten systematic reviews on this topic, published since 1992, from database searches of chiropractic literature17-26. These reviews ranged from meta-analyses with statistical pooling to narrative summaries. An additional report has recently been published by the Cochrane Collaboration (titled “Spinal manipulative Therapy for Low Back Pain”), however the full report is not currently accessible.
  • Clinical trials: The above systematic reviews identified 213 randomised controlled trials undertaken between 1952 and 2002. The authors of the most recently published metaanalysis identified 38 clinical trials, representing approximately 5,000 patients17. This review studied spinal manipulation delivered by a wide variety of health practitioners, including chiropractors. At least three clinical trials (involving between 480 and 1,350 people) of low back pain and spinal manipulation are currently underway (www.controlled-trials.gov).
  • Case-control studies/Cohort studies/Case studies: Given the extensive coverage of the above systematic reviews, no case-control, cohort studies or case studies were assessed for this evidence summary.
  • Guidelines: This evidence summary identified three clinical guidelines related to this topic1, 2, 27.

Safety information


Systematic reviews: Four systematic reviews published since 19966, 18-19, 21 reported information on side effects associated with the use of spinal manipulation for acute low back pain. Other studies: Given the comprehensive information provided by the above studies, no further information on side effects was sought.


Evidence on efficacy


Spinal manipulation is recommended in the New Zealand Clinical Guidelines as a beneficial treatment for acute low back pain1. Current evidence from a recent, high-quality systematic review17 summarizing data from 38 clinical trials generally found that: Spinal manipulation had a beneficial effect on the symptoms of acute low back pain (pain and reduced mobility) in the first 4-6 weeks. Spinal manipulation appears to be as effective as other treatments for acute low back pain, such as physiotherapy and pain relief medication. It remains unclear as to which people will benefit most from spinal manipulation or what the best spinal manipulative therapies are. Results from the other nine systematic reviews conducted since 1992 were broadly consistent with these findings18-26.


Evidence on safety


Current research classifies side effects associated with spinal manipulation into three groups:19

  • Mild and reversible side effects: These effects include muscle and joint soreness and are reported by approximately 50% of patients19.
  • Serious, but reversible side effects: These effects include vertigo or dizziness of a few minutes duration, sternocostal cartilage separation, rib fracture, transient ischemic attacks caused by vertebral artery irritation, and progression of neurologic deficits because of cervical and lumbar disc herniation19. These side effects are reported to be rare. In a review of articles published prior to 1996, 295 side effects associated with spinal manipulations were reported6, 21, of which 56 complications such as dislocations and fractures were reported. Exact risk figures are not available.
  • Serious, irreversible side effects: These effects include arterial dissection, stroke, cauda equina syndrome or death21. The majority of these complications tend to be associated with forceful, rotational, upper spinal manipulation (also called rotational cervical manipulation)6,21. Risk estimates for the cauda equina syndrome are extremely low, ranging from about one case per 100 million manipulations to less than one per million manipulations18. The risk of a serious cerebrovascular complication is approximately one per million cervical (neck) manipulations19.

Cited references


  1. Acute Low Back Pain Guideline Team. New Zealand acute low back pain guide. NewZealand Guidelines Group; Available from http://nzgg.org.nz/library/gl_complete/backpain1/index.cfm#contents Accessed on 3.11.03.
  2. Directorate of Information and Clinical Effectiveness (DICE). Topic of the month: acuteand chronic low back pain. DICE; Available fro http://www.show.scot.nhs.uk/hhb/PUBLICAT/TOPIC%20OF%20MONTH/Dec%20201%20Low%20Back%20Pain/ACUTE%20&%20CHRONIC%20LOW%20BACK%20PAIN.pdf.
  3. Ernst E, Pilter M, Stevinson C, White A. The desktop guide to Complementary and Alternative Medicine: an evidence-based approach. London: Mosby; 2001.
  4. Anonymous. Summaries for patients: the effectiveness of spinal manipulation relative to other therapies for low back pain. Annals of Internal Medicine 2003;138(11):33I.
  5. British Chiropractic Association. Chiropractic: a helping hand for you and your patients. Available from: http://www.chiropractic-uk.co.uk/ accessed on 18/04/03. Berkshire, UK: British Chiropractic Association; 2000.
  6. Stevinson C, Ernst E. Risks associated with spinal manipulation. American Journal of Medicine 2002;112(7):566-571.
  7. Ernst E. Does spinal manipulation have specific treatment effects? Family Practice 2000;17(6):554-556.
  8. New Zealand Chiropractic Board. New Zealand Chiropractic Board homepage. Available from: http://www.regboards.co.nz/chiropractic Accessed on 10 March 2004.
  9. Ministerial Advisory Committee on Complementary and Alternative Health. Public funding for CAM services: ACC subsidies. New Zealand Ministry of Health; Available from: http://www.newhealth.govt.nz/maccah/publicfunding.htm Accessed on 10th March 2004.
  10. The Physiotherapy Board of New Zealand. Physiotherapists: registration.
  11. Medical Council of New Zealand. Medical Registration. Available from: http://www.mcnz.org.nz/registation Accessed on: 10th March 2004.
  12. The British School of Osteopathy. Osteopathy explained. Available from: http://www.bso.ac.uk/osteopathy.htm Accessed on 9th March 2004.
  13. Australian Osteopathic Association. Australian Osteopathic Association: about. Available from: http://www.osteopathic.com.au/about.htm Accessed on 9th March 2004.
  14. The Chartered Society of Physiotherapy. What is physiotherapy? Available from: http://www.csp.org.uk/physiotherapy/whatisphysio.cfm Accessed on: 10th March 2004.
  15. Australian Physiotherapy Association. What is physiotherapy? Available from: http://apa.advsol.com.au/ Accessed on 10th March 2004.
  16. School of Physiotherapy. What is a physiotherapist? University of Otago; Available from: http://physio.otago.ac.nz/becoming_a_physio/physios_are.asp Accessed on: 9th March 2004.
  17. Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain - A meta-analysis of effectiveness relative to other therapies. Annals of Internal Medicine 2003;138(11):871-881.
  18. Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Annals of Internal Medicine 2003;138(11):898-906.
  19. Bronfort G. Spinal manipulation: current state of research and its indications. Neurologic Clinics. 1999;17(1):91-111.
  20. Mohseni-Bandpei MA, Stephenson R, Richardson B. Spinal manipulation in the treatment of low back pain: a review of the literature with particular emphasis on randomized controlled clinical trials [Review]. Physical Therapy Reviews 1998;3(4):185- 194.
  21. Assendelft WJ, Bouter LM, Knipschild PG. Complications of spinal manipulation: a comprehensive review of the literature. Journal of Family Practice. 1996;42(5):475-480.
  22. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21(24):2860-2871; discussion 2872-2873.
  23. Anderson R, Meeker WC, Wirick BE, Mootz RD, Kirk DH, Adams A. A meta-analysis of clinical trials of spinal manipulation. Journal of Manipulative & Physiological Therapeutics 1992;15(3):181-194.
  24. Assendelft WJJ, Koes BW, Van der Heijden G, Bouter LM. The efficacy of chiropractic manipulation for back pain: Blinded review of relevant randomized clinical trials. Journal of Manipulative & Physiological Therapeutics 1992;15(8):487-494.
  25. Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH. Spinal manipulation for low-back pain.[comment]. Annals of Internal Medicine. 1992;117(7):590-598.
  26. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM, Knipschild PG. Spinal manipulation and mobilisation for back and neck pain: a blinded review. BMJ 1991;303(6813):1298-1303.
  27. Royal College of General Practitioners. Clinical guidelines for the management of acute low back pain. London: Royal College of General Practitioners; 2001.

Additional references:


  1. Abenhaim L, Bergeron AM. 20 Years of Randomized Clinical-Trials of Manipulative Therapy for Back Pain - a Review. Clinical and Investigative Medicine-Medecine Clinique Et Experimentale 1992;15(6):527-535.
  2. Accident Rehabilitation and Compensation Insurance Corporation (ACC). Acute low back pain management: patient guide. Wellington: ACC; 1998.
  3. Accident Rehabilitation and Compensation Insurance Corporation (ACC). Guide to assessing psychological yellow flags in acute low back pain. Wellington: ACC; 1997.
  4. Accident Rehabilitation and Compensation Insurance Corporation (ACC). Preventing low back injuries: literature review. ACC; 1998. Available from: http://www.acc.co.nz/acc-publications/pdfs/ip/backs-literaturereview-1998.pdf Accessed on 30.01.04.
  5. Acute Low Back Pain Guideline Team. New Zealand acute low back pain guide. New Zealand Guidelines Group; 1998. Available from: http://nzgg.org.nz/library/gl_complete/backpain1/index.cfm#contents Accessed on 3.11.03.
  6. Anderson R. A meta-analysis of clinical trials of spinal manipulation. DC 1999;Tracts. 11(3):8-9.
  7. Andersson GBJ, Lucente T, Davis AM, Kappler RE, Lipton JA, Leurgans S. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. New England Journal of Medicine 1999;341(19):1426-1431.
  8. Anonymous. Chronic back and neck pain: new evidence confirms the effectiveness of chiropractic manipulation. Chiropractic Report 2000;14(1):1-3.
  9. Anonymous. Comparison of chiropractic and hospital outpatient management of low back pain: a feasibility study. Report of a working group. Journal of Epidemiology & Community Health 1986;40(1):12-7.
  10. Anonymous. Conservative treatments for low back pain -- which is most effective? (n=206). Acupuncture in Medicine 2002;20(4):197-8.
  11. Anonymous. For low back pain, chiropractic care and McKenzie-style PT only slightly better than one-dollar booklet. Joint Letter 1998;4(9):97.
  12. Anonymous. Low back pain: comparison of chiropractic and hospital outpatient treatment. BMJ 1990;301(6747):341-2.
  13. Anonymous. Spinal manipulation. Medical Letter on Drugs & Therapeutics 2002;44(1131).
  14. Assendelft WJ, Bouter LM, Kessels AG. Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British Randomized Clinical Trial. Journal of Manipulative & Physiological Therapeutics 1991;14(5):281-6.
  15. Assendelft WJ, Koes BW, Knipschild PG, Bouter LM. The relationship between methodological quality and conclusions in reviews of spinal manipulation.[comment]. JAMA 1995;274(24):1942-8.
  16. Assendelft WJ, Koes BW, van der Heijden GJ, Bouter LM. The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling. Journal of Manipulative & Physiological Therapeutics 1996;19(8):499-507.
  17. Assendelft WJJ, Bouter LM, Kessels AGH. Effectiveness of chiropractic and physiotherapy in low back pain. A critical discussion of the British randomized clinical trial. [German]. Manuelle Medizin 1993;31(2):34-38.
  18. Aure OF, Nilsen JH, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain - A randomized, controlled trial with 1-year follow-up. Spine 2003;28(6):525-531.
  19. Barker ME. Spinal manipulation. A general practice study. Manuelle Medizin 1995;33(6):173-175.
  20. Beira B, Peers A. A study of the effects of chiropractic therapy on the diameter of the spinal canal in patients with low back pain and radiculopathy. JNMS: Journal of the Neuromusculoskeletal System 1998;6(3):114-26.
  21. Borge JA, Leboeuf-Yde C, Lothe J. Review of the literature. Prognostic view of physical examination findings in patients with chronic low back pain treated conservatively: a systematic literature review [corrected] [published erratum appears in J Manipulative and Physiological Therapeutics 2001 Jun; 24(5): 355]. Journal of Manipulative & Physiological Therapeutics 2001;24(4):292-5.
  22. Breen A, Breen R. Back pain and satisfaction with chiropractic treatment: What role does the physical outcome play? Clinical Journal of Pain 2003;19(4):263-268.
  23. Breen A. Chiropractic for low back pain - Experts in both UK and US believe that chiropractic works. British Medical Journal 1999;318(7178):261-261.
  24. Brennan PC, Graham MA, Triano JJ, Hondras MA, Anderson RJ. Lymphocyte profiles in patients with chronic low back pain enrolled in a clinical trial. Journal of Manipulative & Physiological Therapeutics 1994;17(4):219-27.
  25. Breuner CC. Complementary medicine in pediatrics: A review of acupuncture, homeopathy, massage, and chiropractic therapies. Current Problems in Pediatric & Adolescent Health Care 2002;32(10):353-384.
  26. Brien P. Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British clinical trial. Journal of Manipulative & Physiological Therapeutics 1991;14(9):541-4.
  27. Brien P. Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British clinical trial. Journal of Manipulative & Physiological Therapeutics 1991;14(9):541-4.
  28. Bronfort G, Evans RL, Anderson AV, Schellhas KP, Garvey TA, Marks RA, et al. Nonoperative treatments for sciatica: A pilot study for a randomized clinical trial. Journal of Manipulative and Physiological Therapeutics 2000;23(8):536-544.
  29. Bronfort G, Goldsmith CH, Nelson CF, Boline PD,Anderson, AV. Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer-blinded clinical trial. Journal of Manipulative & Physiological Therapeutics 1996;19(9):570-82.
  30. Bronfort G. Chiropractic treatment of low back pain: a prospective survey. European Journal of Chiropractic 1986;34(4):182-211.
  31. Bronfort G. Chiropractic treatment of low back pain: a prospective survey. Journal of Manipulative & Physiological Therapeutics 1986;9(2):99-113.
  32. Bronfort G. Chiropractic versus general medical treatment of low back pain: a small scale controlled clinical trial. American Journal of Chiropractic Med 1989;2(4):145-50.
  33. Brunarski DJ. Clinical trials of spinal manipulation: a critical appraisal and review of the literature. Journal of Manipulative & Physiological Therapeutics 1984;7(4):243-9.
  34. Carey TS. Chiropractic manipulation and McKenzie physiotherapy were not effective for low back pain... commentary on Cherkin DC, Deyo RA, Battie M et al. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. New England Journal of Medicine 1998 Oct 8;339:1021-9. ACP Journal Club 1999;130(2):42.
  35. Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. New England Journal of Medicine 1998;339(15):1021-9.
  36. Conijn FJJ. Re: Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine 2003;28(14):1625-1626.
  37. Cooperstein R, Perle SM, Gatterman MI, Lantz C, Schneider MJ. Chiropractic technique procedures for specific low back conditions: characterizing the literature. Journal of Manipulative & Physiological Therapeutics 2001;24(6):407-24.
  38. Cooperstein RPS. Condition-specific indications for chiropractic adjustive procedures for the low back: literature and clinical effectiveness ratings of an expert panel. Topics in Clinical Chiropractic 2002;9(3):19-29.
  39. Cote P, Mior SA, Vernon H. The short-term effect of a spinal manipulation on pain/pressure threshold in patients with chronic mechanical low back pain. Journal of Manipulative & Physiological Therapeutics 1994;17(6):364-8.
  40. Coulter ID. Efficacy and risks of chiropractic manipulation: What does the evidence suggest? Integrative Medicine 1998;1(2):61-66.
  41. Cramer GD, Gregerson DM, Knudsen JT, Hubbard BB, Ustas LM, Cantu JA. The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects. Spine 2002;27(22):2459-66.
  42. Currie H. A critical analysis of the evidence for chiropractic treatment of low back pain. Journal of Orthopaedic Nursing 2001;5(1):4-8.
  43. Di Fabio RP. Efficacy of manual therapy. Physical Therapy 1992;72(12):853-64.
  44. Directorate of Information and Clinical Effectiveness (DICE). Topic of the month: acute and chronic low back pain. DICE; 2001. Available from: http://www.show.scot.nhs.uk/hhb/PUBLICAT/TOPIC%20OF%20MONTH/Dec%20200 1%20Low%20Back%20Pain/ACUTE%20&%20CHRONIC%20LOW%20BACK%20P AIN.pdf Accessed on 11.11.03.
  45. Dishman JD, Bulbulian R. Spinal reflex attenuation associated with spinal manipulation. Spine 2000;25(19):2519-24;discussion 2525.
  46. Edmondston S. Spinal manipulation for chronic low back pain - Where to from here? (Comment on Ferreira et al, Australian Journal of Physiotherapy 48:277-284.). Australian Journal of Physiotherapy 2003;49(1):63-64.
  47. Enebo BA. Conservative management of chronic low back pain using mobilization: a single-subject descriptive case study. Chiropractic Technique 1998;10(2):68-74.
  48. Ernst E, Assendelft WJ. Chiropractic for low back pain. We don't know whether it does more good than harm. BMJ 1998;317(7152):160.
  49. Ernst E, Harkness E. Spinal manipulation: A systematic review of sham-controlled, double-blind, randomized clinical trials. Journal of Pain & Symptom Management 2001;22(4):879-889.
  50. Ernst E, Pittler MH. Experts' opinions on complementary/alternative therapies for low back pain. Journal of Manipulative & Physiological Therapeutics 1999;22(2):87-90.
  51. Ernst E. Chiropractic manipulation for non-spinal pain: a systematic review. New Zealand Medical Journal 2003;116(1179):U539.
  52. Ernst E. Complementary medicine: an objective appraisal. Oxford: Butterworth- Heinemann; 1996.
  53. Ernst E. Massage therapy for low back pain: a systematic review. Journal of Pain & Symptom Management 1999;17(1):65-9.
  54. Ernst E. Prospective investigations into the safety of spinal manipulation. Journal of Pain & Symptom Management 2001;21(3):238-42.
  55. Ernst E. Spinal manipulation: its safety is uncertain. CMAJ: Canadian Medical Association Journal 2002;166(1):40-1.
  56. Ernst E. The use, efficacy, safety and costs of complementary/alternative therapies for low back pain. European Journal of Physical Medicine & Rehabilitation 1998;8(2):53-57.
  57. Ferreira ML, Ferreira PH, Latimer J, Herbert R, Maher CG. Does spinal manipulative therapy help people with chronic low back pain? Australian Journal of Physiotherapy 2002;48(4):277-84.
  58. Freeman MD, Rossignal AM. A critical evaluation of the methodology of a low-back pain clinical trial. Journal of Manipulative & Physiological Therapeutics 2000;23(5):363-
  59. French SD, Green S, Forbes A. Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain. Journal of Manipulative & Physiological Therapeutics 2000;23(4):231-8.
  60. Furlan AD, Brosseau L, Imamura M, Irvin E. Massage for low back pain. (Cochrane Review) Cochrane Database of Systematic Reviews; 2003.
  61. Gatchel RJ. Chronic spinal pain: A randomized clinical trial comparing medication, acupuncture, and spinal manipulation - Point of view. Spine 2003;28(14):1502-1503.
  62. Gemmell HA, Jacobson BH. Comparison of two adjustive indicators in patients with acute low back pain. Chiropractic Technique 1998;10(1):8-10.
  63. Gemmell HA, Jacobson BH. The immediate effect of activator vs. meric adjustment on acute low back pain: a randomized controlled trial. Journal of Manipulative & Physiological Therapeutics 1995;18(7):453-6.
  64. Giles LG, Muller R. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. Journal of Manipulative & Physiological Therapeutics 1999;22(6):376-81.
  65. Giles LGF, Muller R. Chronic spinal pain: A randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 2003;28(14):1490-1502.
  66. Goldberg H. Spinal manipulation is appropriate for low back pain: fact or fiction? Focus on Alternative & Complementary Therapies 2003;8(1):14-8.
  67. Greenough CG. Comparing hospital and chiropractic treatment for back pain - results were clinically trivial. BMJ 1995;311(7015):1302-1302.
  68. Hadler NM, Curtis P, Gillings DB, Stinnett S. A benefit of spinal manipulation as adjunctive therapy for acute low-back pain: a stratified controlled trial. Spine 1987;12(7):702-6
  69. Haldeman S, Rubinstein SM. Compression fractures in patients undergoing spinal manipulative therapy. Journal of Manipulative & Physiological Therapeutics 1992;15(7):450-4.
  70. Hamann G, Felber S, Haas A, Stristtmatter M, Kujat C, Schimrigk K, et al. Cervicocephalic artery dissections due to chiropractic manipulations. Lancet 1993;341(8847):764-5.
  71. Harvey E, Burton AK, Moffett JK, Breen A, team UBt. Spinal manipulation for low-back pain: a treatment package agreed to by the UK chiropractic, osteopathy and physiotherapy professional associations. Manual Therapy 2003;8(1):46-51.
  72. Hawk C, Azad A, Phongphua C, Long CR. Preliminary study of the effects of a placebo chiropractic treatment with sham adjustments. Journal of Manipulative & Physiological Therapeutics 1999;22(7):436-43.
  73. Hawk C, Phongphua C, Bleecker J, Swank L, Lopez D, Rubley T. Preliminary study of the reliability of assessment procedures for indications for chiropractic adjustments of the lumbar spine. Journal of Manipulative & Physiological Therapeutics 1999;22(6):382-9.
  74. Hawk C. Interdisciplinary care. An evidence-based look at chiropractic: tailoring treatment for older adults. Journal of Gerontological Nursing 2002;28(4):6-14.
  75. Hayden JA, Mior SA, Verhoef MJ. Evaluation of chiropractic management of pediatric patients with low back pain: A prospective cohort study. Journal of Manipulative and Physiological Therapeutics 2003;26(1):1-8.
  76. Hemmila HM, Keinanen-Kiukaanniemi SM, Levoska S, Puska P. Long-term effectiveness of bone-setting, light exercise therapy, and physiotherapy for prolonged back pain: a randomized controlled trial. Journal of Manipulative & Physiological Therapeutics 2002;25(2):99-104.
  77. Hertzman-Miller RP, Morgenstern H, Hurwitz EL, Yu F, Adams AH, Harber P, et al. Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study. American Journal of Public Health 2002;92(10):1628-33.
  78. Hoehler FK, Tobis JS, Buerger AA. Spinal manipulation for low back pain. Jama 1981;245(18):1835-8.
  79. Hoiriis KT, Owens EF, Jr., Pfleger B. Changes in general health status during upper cervical chiropractic care: a practice-based research project. CRJ: Chiropractic Research Journal 1997;4(1):18-26.
  80. Hoiriis KT, Pfleger B, McDuffie F, Cotsanis G, Elsangak O, Versosa GT. A randomized clinical trial comparing chiropractic to conservative medical care for subacute low back pain. European Journal of Chiropractic 2002;49(1):101.
  81. Hoiriss KT, Pfleger B, McDuffie FC, Alattar M, Owens EF. Design and implementation of a randomized controlled clinical trial of chiropractic care versus drug therapy for subacute low back pain. CRJ: Chiropractic Research Journal 1997;4(2):50-63.
  82. Hosek RS, Schram SB, Silverman H, Myers JB, Williams SE. Cervical manipulation. JAMA 1981;245(9):922.
  83. Hsieh CY, Phillips RB, Adams AH, Pope MH. First prize: Functional outcomes of low back pain: Comparison of four treatment groups in a randomized controlled trial. Journal of Manipulative & Physiological Therapeutics 1992;15(1):4-9.
  84. Hsieh CYJ, Adams AH, Tobis J, Hong CZ, Danielson C, Platt K, et al. Effectiveness of four conservative treatments for subacute low back pain - A randomized clinical trial. Spine 2002;27(11):1142-1148.
  85. Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 1996;21(15):1746-59; discussion 1759-60.
  86. Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Belin TR, Yu F, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine 2002;27(20):2193-204.
  87. Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Belin TR, Yu F, et al. The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: Findings from the UCLA low back pain study (vol 25, pg 10, 2002). Journal of Manipulative and Physiological Therapeutics 2002;25(3):183-183.
  88. Hurwitz EL, Morgenstern H, Harber P, Kominsky GF, Belin TR, Yu F, et al. The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: Findings from the UCLA low back pain study. Journal of Manipulative & Physiological Therapeutics 2002;25(1):10-20.
  89. Hurwitz EL, Morgenstern H, Harber PI, Kominski G, Belin TR, Yu F, et al. Effectiveness of physical modalities among low back pain patients randomized to chiropractic care: findings from the UCLA low-back pain study... symposium proceedings of the World Federation of Chiropractic 6th Biennial Congress, Paris, France, 21-26 May 2001. European Journal of Chiropractic 2002;49(1):102-3.
  90. Hurwitz EL. The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: Findings from the UCLA low back pain study - In responce. Journal of Manipulative and Physiological Therapeutics 2002;25(8):539-540.
  91. Keller TS, Colloca CJ. Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: a comparative clinical trial. Journal of Manipulative & Physiological Therapeutics 2000;23(9):585-95.
  92. Koes BW, Bouter LM, van der Heijden GJ. Methodological quality of randomized clinical trials on treatment efficacy in low back pain. Spine 1995;20(2):228-35.
  93. Koes BW, Bouter LM, Vanmameren H, Essers AHM, Verstegen G, Hofhuizen DM, et al. Randomized clinical-trial of manipulative therapy and physiotherapy for persistent back and neck complaints - results of one year follow-up. British Medical Journal 1992;304(6827):601-605.
  94. Lee KP, Carlini WG, McCormick GF, Albers GW. Neurologic complications following chiropractic manipulation: a survey of California neurologists. Neurology 1995;45(6):1213-5.
  95. Leerberg E. Efficacy of spinal manipulation for low back pain has not been reliably shown. British Medical Journal 1999;318(7178):261-262.
  96. Lorme KJ, Naqvi SA. Comparative analysis of low-back loading on chiropractors using various workstation table heights and performing various tasks. Journal of Manipulative and Physiological Therapeutics 2003;26(1):25-33.
  97. Maire JM. Evaluating the effectiveness of care in neck and back pain: pain and functional status as outcome measures. Australasian Chiropractic & Osteopathy 2002;10(1):16-20.
  98. McDonald JC, Lundgren KL. The Progressive Dynamic Lumbar Stabilization program for the treatment of musculoskeletal dysfunctions that contribute to mechanical low back pain. Journal of Sports Chiropractic & Rehabilitation 1998;12(2):55-64.
  99. McMorland G, Suter E. Chiropractic management of mechanical neck and low-back pain: A retrospective, outcome-based analysis. Journal of Manipulative and Physiological Therapeutics 2000;23(5):307-311.
  100. Meade TW, Assendelft WJJ, Bouter LM, Kessels AGH. Effectiveness of chiropractic and physiotherapy in the treatment of low back pain. A critical discussion of the British randomized clinical trial. Journal of Manipulative & Physiological Therapeutics 1991;14(7):444-446.
  101. Meade TW, Browne W, Mellows S, Townsend J, Webb J. Comparison of chiropractic and hospital outpatient management of low back pain: a feasibility study. European Journal of Chiropractic 1986;34(4):172-81.
  102. Meade TW, Dyer S, Browne W, Frank AO. Randomised comparison of chiropractic and hospital outpatient management for low back pain: Results from extended follow up. BMJ 1995;311(7001):349-351. 103.
  103. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ 1990;300(6737):1431-7. 104.
  104. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment. European Journal of Chiropractic 1990;38(3):92-107.
  105. Meade TW. Patients were more satisfied with chiropractic than other treatments for low back pain. BMJ 1999;318(7201);57.
  106. Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Annals of Internal Medicine 2002;136(3):216-27.
  107. Nicholson WR. Chromic spinal pain syndromes: A clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. Journal of Manipulative and Physiological Therapeutics 2000;23(4):297-298.
  108. Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and onemonth outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. Journal of Manipulative & Physiological Therapeutics 2000;23(4):239-45.
  109. Okawara S, Nibbelink D. Vertebral artery occlusion following hyperextension and rotation of the head. Stroke 1974;5(5):640-2.
  110. Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LJ. A new approach to the treatment of chronic low back pain. Lancet 1987;2(8551):143-6.
  111. Palmieri NF, Smoyak S. Chronic low back pain: a study of the effects of manipulation under anesthesia. Journal of Manipulative & Physiological Therapeutics 2002;25(8):E8- E17.
  112. Parkin-Smith GF. Manipulation for low back pain. Physiotherapy 1997;83(11):606-7.
  113. Pengel HM, Maher CG, Refshauge KM. Systematic review of conservative interventions for subacute low back pain. Clinical Rehabilitation 2002;16(8):811-820
  114. Pope MH, Phillips RB, Haugh LD, Hsieh CY, MacDonald L, Haldeman S. A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine 1994;19(22):2571- 7.
  115. Powell FC, Hanigan WC, Olivero WC. A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurgery 1993;33(1):73-8; discussion 78-9.
  116. Preyde M. Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. Canadian Medical Association Journal 2000;162(13):1815-1820.
  117. Rosner AL. Commentary. Chiropractic: more good than harm or vice versa?... Ernst E, Assendelft WJJ. Chiropractic for low back pain: we don't know whether it does more good than harm [editorial]. BMJ 1998;317:160. Journal of Manipulative & Physiological Therapeutics 1999;22(4):250-3.
  118. Royal College of General Practitioners. Clinical guidelines for the management of acute low back pain. London: Royal College of General Practitioners; 2001.
  119. Rupert R. The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: findings from the UCLA low back pain study. Journal of Manipulative & Physiological Therapeutics 2002;25(8):538-9; discussion 539-40.
  120. Senstad O, Leboeuf-Yde C, Borchgrevink C. Frequency and characteristics of side effects of spinal manipulative therapy. Spine 1997;22(4):435-40; discussion 440-1.
  121. Sheahan PA, Seaton TL. Alternative therapy for low back pain. Journal of Family Practice 1999;48(1):10-1.
  122. Shekelle PG, Coulter I, Hurwitz EL, Genovese B, Adams AH, Mior SA, et al. Congruence between decisions to initiate chiropractic spinal manipulation for low back pain and appropriateness criteria in North America. Annals of Internal Medicine 1998;129(1):9-17.
  123. Shekelle PG, Hurwitz EL, Coulter I, Adams AH, Genovese B, Brook RH. The Appropriateness of Chiropractic Spinal Manipulation for Low-Back-Pain - a Pilot-Study. Journal of Manipulative and Physiological Therapeutics 1995;18(5):265-270.
  124. Shekelle PGCI. Cervical spine manipulation: summary report of a systematic review of the literature and a multidisciplinary expert panel. Journal of Spinal Disorders 1997;10(3):223-8.
  125. Sheres BM. Chiropractic efficacy progress report: treatment of spinal neuralgia, cephalgia, vertigo and related peripheral conditions. CRJ Chiropractic Research Journal 1993;2(3):17-32.
  126. Sierpina VS, Curtis P, Doering J. An integrative approach to low back pain. Clinics in Family Practice 2002;4(4):817-831.
  127. Skargren EI, Carlsson PG, Oberg BE. One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain: subgroup analysis, recurrence, and additional health care utilization... including commentary by Carey TS. Spine 1998;23(17):1875-84.
  128. Skargren EI, Oberg BE, Carlsson PG, Gade M. Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain. Six-month followup. Spine 1997;22(18):2167-77.
  129. Smith D, McMurray N, Disler P. Early intervention for acute back injury: can we finally develop an evidence-based approach? Clinical Rehabilitation 2002;16(1):1-11.
  130. Smithers MD. The efficacy of manual treatment in low back pain: a clinical trial... commentary on Arkuszewski Z. Man Med 1986;2:68-71. DC 2001;Tracts. 13(1):16-7.
  131. Snow GJ. Chiropractic management of a patient with lumbar spinal stenosis. Journal of Manipulative & Physiological Therapeutics 2001;24(4):300-4.
  132. Spencer JW, Jacobs JJ. Complementary/alternative medicine: an evidence-based approach. St. Louis: Mosby; 1999.
  133. Stern PJ, Cote P, Cassidy JD. A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors. Journal of Manipulative & Physiological Therapeutics 1995;18(6):335-42.
  134. Suter E, McMorland G, Herzog W, Bray R. Conservative lower back treatment reduces inhibition in knee-extensor muscles: a randomized controlled trial. Journal of Manipulative & Physiological Therapeutics 2000;23(2):76-80.
  135. Terrett AG, Kleynhans AM. Cerebrovascular complications of manipulation. In: Haldeman S, editor. Principles and practice of chiropractic. 2nd ed. Norwalk, CT: Appleton & Lange; 1992. p. 579-598.
  136. Triano J, Schultz AB. Loads transmitted during lumbosacral spinal manipulative therapy. Spine 1997;22(17):1955-64.
  137. van der Weide WE, Verbeek JH, van Tulder MW. Vocational outcome of intervention for low-back pain. Scandinavian Journal of Work, Environment & Health 1997;23(3):165- 78.
  138. van Tulder M, Furlan A, Bombardier C, Bouter L, Editorial Board of the Cochrane Collaboration Back Review G. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine 2003;28(12):1290-9.
  139. Verhagen AP, van Beek H, van Tulder MW. Effectiveness of manual therapy; state of the art [Dutch]. Nederlands Tijdschrift fur Fysiotherapie 2002;112(6):138-42.
  140. Vernon H. Spinal manipulation for chronic low back pain: a review of the evidence. Topics in Clinical Chiropractic 1999;6(2):8-12.
  141. Vickers A, Zollman C. The manipulative therapies: Osteopathy and chiropractic. BMJ 1999;319(7218):1176-1179.
  142. Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone; 1998.
  143. Wakefield A, Bull A. Comparing hospital and chiropractic treatment for back pain - trial did not compare like with like. British Medical Journal 1995;311(7015):1301-1302.
  144. White AR. Comparing osteopathic manipulation and standard back pain care: more difficult than you think. Focus on Alternative & Complementary Therapies 2000;5(2):131-2.
  145. Williams SE, Penn PF, Owens EF, Hosek RS, Burneskis RD, Bloomingdale SA, et al. A progress report of chiropractic efficacy in the treatment of chronic low back pain, neck pain, headaches and related peripheral conditions: a double blinded time-series study. Crj: Chiropractic Research Journal 1989;1(3):11-21.
  146. Yong-Hing K. Sacro-iliac joint pain: etiology and conservative treatment. Chirurgia Degli Organi di Movimento 1994;79(1):35-45.

Glossary


Cauda equina syndrome
Cauda equina syndrome is characterised by dull pain in the lower back and upper buttock region, numbness in the buttocks, genitalia (or thigh) accompanied by a disturbance of bowel and bladder function.

Cerebrovascular
Cerebrovascular refers to the blood vessels of the cerebrum or brain.

Disk herniation
Disk herniation refers to a condition that results in the abnormal protrusion (bulging), herniation, or prolapse of a vertebral disk from its normal position in the vertebral column.

Sternocostal cartilage separation
Sternocostal cartilage separation is the separation of the cartilage in the breast-bone (sternum).

Transient ischaemic attack
Transient ischaemic attack (TIA) is a sudden focal loss of neurological function with complete recovery usually within 24 hours.

Vertebrobasilar accident
A vertebrobasilar accident results in vertebrobasilar insufficiency which is an obstruction or stenosis of the vertebral-basilar system manifested by disturbances of consciousness, vertigo, headache, hemi- or quadriplegia, dysarthria (imperfect articulation of speech due to disturbances of muscular control which result from damage to the central or peripheral nervous system), and facial paralysis.

DISCLAIMER: This summary does not provide specific medical advice and the information provided should not be used as a substitute for seeking medical advice from a registered health practitioner.
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