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Acute Pain | Chronic Pain | General

Spinal manipulation and mobilisation for back pain

Clinical bottom line: Based on poor quality trials, there is no evidence that spinal manipulation and mobilisation is useful in relieving acute or chronic back pain. Any benefits that may be derived disappear with longer-term follow-ups ("e3 months).

Back pain is a very common complaint, with about 80% of people experiencing this at some time during their lives. Most patients will recover from an attack of back pain within six weeks, even when no treatment is given. A number of different therapists carry out spinal manipulation and mobilisation for back pain, including osteopaths, chiropractors and physiotherapists. Manipulation involves a high velocity thrust to a joint beyond its restricted range of movement, and mobilisation uses low velocity passive movements within or at the limit of the joint range. However, there are also differences amongst the different techniques used to do this.

Systematic review

Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM, Knipschild PG. Spinal manipulation and mobilisation for back and neck pain: a blinded review [see comments]. BMJ. 1991; 303: 1298-303.

Inclusion criteria were randomised controlled trials of spinal manipulation (including mobilisation) for back pain.

Reviewers based their conclusion on those of the original trials.

Findings

Active comparisons

Trials were generally of poor quality, and differed in design, intervention, controls, follow-up periods, etc. Control treatments included physiotherapy, analgesics, bedrest, massage, corset, back school, short wave diathermy, etc.

15 of 30 trials showed significant benefit over control treatments, and nine did not.

Six of 30 trials were only positive on a sub-group analysis, or no conclusion was drawn.

In general, the higher quality trials tended to report negative effects.

Longer-term follow-up ("e3 months): Of the 14 trials measuring this, only four reported long-term benefits.

Placebo comparisons

Placebo was usually sham short wave diathermy, and patients were a mixture of acute and chronic. Four of eight trials reported benefit of manipulation, one for a sub-group analysis only, and three reported no benefit. No long-term benefits attributable to manipulation were found.

Adverse effects

The review did not cover adverse effects.

Further Reading

The following reviews are all superseded by the current review:

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