Date Last Updated: 08/08/06
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Does chiropractic treatment help with low-back pain?

 

Treatment in brief
Chiropractic is a health profession concerned mainly with problems with muscles, bones and their associated tissues. There is an emphasis on manual treatments including spinal manipulation or adjustment, and this is often combined with other therapies

The condition
Low-back pain is a very common complaint. The cause of pain is non-specific in most people presenting with acute low-back pain but some do become chronic. Chronic low-back pain is a disabling condition, costly to both individuals and society.

Back pain is a condition for which chiropractic treatment is often recommended

Background
Chiropractic treatments are commonly used in developed countries by low-back pain sufferers. In Australia, consultation to a chiropractor is the second most sort out treatment for low-back pain, with 19% seeking chiropractic treatment. This has been a consistent finding in other developed countries.

The evidence
There appears to be some evidence from one systematic review and four other studies, although not conclusive, that chiropractic treatment is as effective as other therapies but this may be due to chance. There is very little evidence that chiropractic is more effective than other therapies.

One study found that combined chiropractic and myofascial therapy was as effective as either therapy alone. However, it is difficult to determine whether these therapies are more effective than no treatment.

Another study found that chiropractic was more beneficial in reducing pain than placebo and more beneficial than placebo or muscle relaxants in reducing a measurement of severity.

Another found that chiropractic treatment and medical care were similar in their effectiveness. There was a possible small benefit of physical therapy in reducing disability compared to medical care.

Other important issues
Adverse effects of chiropractic treatment were only reported in one study. These were mainly short periods of worsening symptoms. However other reports have described frequent mild adverse effects as well as more serious complications. For information about contraindications and possible adverse effects see:

http://www.webmd.com/content/article/4/1680_50518.htm

Key Message(s)

There is level 4 evidence that chiropractic treatment is as effective as other treatments for low back pain.	3
There is level 2 evidence that chiropractic treatment may help to reduce acute low back pain	2

  

Key: Levels of evidence

 

 

 

The information in this summary was developed by assessing:

Assendelft, W. J., S. C. Morton, et al. (2004). "Spinal manipulative therapy for low back pain. [Review] [105 refs]." Cochrane Database of Systematic Reviews 1.

Bronfort, G., M. Haas, et al. (2004). "Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. [Review] [144 refs]." Spine Journal: Official Journal of the North American Spine Society 4(3): 335-56.

Chapman-Smith, D. (2000). The Chiropractic Profession. 2006. www.chiropracticreport.com/chiropractic.htm

Chiropractic. W. F. o. (1999). WFC Policy Statement, A General Dictionary Definition of Chiropractic. Assembly of the World Federation of Chiropractic, Auckland, New Zealand. http://www.wfc.org/website/WFC/website.nsf/WebPage/Home?OpenDocument&ppos=1&spos=0&rsn=y&Language=EN

Ernst, E. and P. H. Canter (2003). "Chiropractic spinal manipulation treatment for back pain? a systematic review of randomised clinical trials." Physical Therapy Reviews 8(2): 85-91.

Hoiriis, K. T., B. Pfleger, et al. (2004). "A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain." Journal of Manipulative & Physiological Therapeutics 27(6): 388-98.

Hollingworth, W., C. J. Todd, et al. (2002). "Primary care referrals for lumbar spine radiography: diagnostic yield and clinical guidelines.[see comment]." British Journal of General Practice 52(479): 475-80.

Hsieh, C. Y., A. H. Adams, et al. (2002). "Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial." Spine 27(11): 1142-8.

Hurwitz, E. L., H. Morgenstern, et al. (2002). "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.[see comment]." Spine 27(20): 2193-204.

Maniadakis, N. and A. Gray (2000). "The economic burden of back pain in the UK." Pain 84(1): 95-103.

Walker, B. F. (2000). "The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. [Review] [76 refs]." Journal of Spinal Disorders 13(3): 205-17.

Walker, B. F., R. Muller, et al. (2004). "Low back pain in Australian adults. health provider utilization and care seeking." Journal of Manipulative & Physiological Therapeutics 27(5): 327-35.

 

Date prepared:          1 July 2006

 

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