Spinal manipulative therapy linked to modest improvements in pain and function for acute low back pain

1. In a systematic review and meta-analysis, spinal manipulative therapy was associated with statistically significant benefits in both pain and function for acute low back pain at up to 6 weeks.

2. Minor transient adverse effects included increased pain, muscle stiffness, and headache in over half of patients in large case series.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Numerous therapies exist for acute back pain including analgesics, muscle relaxants, exercises, heat, and physical therapy. There is conflicting evidence on the effectiveness of spinal manipulative therapy (SMT), however, and this systematic review and meta-analysis aimed to determine whether it was associated with improvements in pain or function for acute low back pain lasting 6 weeks or less. Several databases and randomized clinical trials (RCTs) were investigated, which demonstrated that SMT had a statistically significant association with improvements in pain and in function at up to 6 weeks. No serious adverse events were reported. Minor adverse events included transient increases in pain, muscle stiffness, and headache.

Overall, this study suggests that for patients with acute low back pain, SMT can provide modest improvements in pain and function with transient, minor adverse events. However, many studies included in this analysis were of low quality, and there was significant unexplained heterogeneity.

Click to read the study, published in JAMA

Relevant Reading: Low back pain

In-Depth [systematic review and meta-analysis]: This study systematically reviewed MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature from 2011-2017 in order to identify systematic reviews and RCTs of adults with low back pain treated with SMT compared to sham or alternative treatments. The primary outcomes of interest were pain, function, quality of life, and adverse events. 15 RCTs including 1711 patients gave moderate-quality evidence that SMT had a statistically significant association with improvements in pain (pooled mean improvement in 100-mm visual analog pain scale, -9.95 [CI_95% -15.6 to -4.3]). 12 RCTs including 1381 patients gave moderate-quality evidence that SMT had a statistically significant association with improvements in function (pooled mean effect size, -0.39 [CI_95% -0.71 to -0.07]). No serious adverse events were reported. Minor adverse events included transient increases in pain, muscle stiffness, and headache were reported 50%-67% of the time with SMT.

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