Should I have spinal manipulative therapy for low back pain?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Spinal manipulative therapy is adjustment of the spine using twisting, pulling, or pushing movements. These movements can loosen and move the spinal bones and joint structures that may be causing pain. This is the basis of chiropractic treatment, but not only chiropractors are trained to do spinal manipulation.
See a chiropractor, an osteopathic doctor, a physiatrist, or a physiotherapist with specialized training in spinal manipulation. Your insurance coverage may be a factor in deciding who to see for treatment.
When deciding about spinal manipulation, consider the following:
- You may need only home treatment, such as ice, moist heat, pain relievers, and mild exercise. For most people, these home treatments usually relieve low back pain within 4 to 6 weeks.
- Before you try spinal manipulation, have your symptoms evaluated. Certain symptoms, such as sharp pain, or low back pain with leg pain or numbness, can be a sign of a serious condition that needs immediate medical treatment or that could be made worse by spinal manipulation.
- You can't count on spinal manipulation alone to treat low back pain. Good spinal manipulative therapy includes self-care information and strength and conditioning exercises that help your muscles better support your troubled joints.
- If you choose spinal manipulation, find a practitioner who is willing to coordinate care with your other health professionals.
Medical Information
What is spinal manipulative therapy for low back pain?
Spinal manipulative therapy is based on the theory that your spinal health is central to your overall health. It relies on spinal manipulation, or spinal manual therapy, to increase a joint's range of motion. Different practitioners use different manipulation techniques, ranging from massage and slow pressing or twisting to rapid movement or forceful pressure on the head, shoulder, back, or hips. If you have tight or spasming muscles, your practitioner may first use a technique such as heat, ultrasound, or electrical current to relax your muscles before manipulating the spine. Practitioners who are not medical doctors do not use medicines or surgery to treat conditions.
People who benefit from spine manipulative therapy usually notice improvement after one visit, and additional manipulation is not needed.1 At most, 2 to 3 weeks of spinal manipulative therapy is considered to be enough to treat acute low back pain. While some practitioners encourage long-term spinal manipulation for "maintenance" or "preventive" reasons, this practise has no proven value.
Chiropractors are not your only choice for providing spinal manipulation. Osteopathic doctors (DOs) are fully credentialed doctors whose training includes an emphasis on manual therapy. Some physiatrists and licensed physiotherapists also have specialized training in spinal manipulation. Health insurance coverage varies for this type of treatment, so it's wise to check whether your practitioner of choice is covered before starting treatment.
How effective is spinal manipulation?
Like other treatments, spinal manipulation helps relieve acute low back pain for some people, but not for others. Spinal manipulation success is influenced by both the practitioner's diagnostic and treatment skill, and the cause of low back pain. Results from randomized controlled trials comparing spinal manipulation and placebo are mixed. While some studies have found spinal manipulation offers better pain relief than placebo, others have found no difference.2, 3
Comparisons between spinal manipulation and other low back pain treatments have produced conflicting results, making solid conclusions difficult. According to some experts, it's difficult to show that one treatment is better than another, because most low back pain improves within the first month regardless of treatment.4
One study has suggested that people are nearly equally satisfied with chiropractic versus medical low back pain care when they are given clear treatment information and at least four suggestions for home treatment. (The study did not include other practitioners such as osteopaths or physiotherapists.)5
What are the risks of spinal manipulative therapy?
Perhaps the most common risks of seeking spinal manipulative therapy are related to a lack of standard practise in this field. Be a smart consumer (as you would be when considering a surgical or experimental back treatment). Ask your medical doctor or physiotherapist for a referral to a practitioner of spinal manipulative therapy. Particularly if you have no referral, interview a practitioner or two before starting treatment.
Slow "mobilizing" movement has no known risks. Should a practitioner offer to work on your neck, however, remember that forceful neck manipulation, as performed by some practitioners, has been linked to rare but serious cases of neurological damage and sometimes death. Rapid neck manipulation can injure vertebral arteries and cause herniated discs, leading to stroke or disability. You can avoid this type of risk with an experienced practitioner who uses slow, gentle manipulation techniques to treat carefully diagnosed conditions. Talk to your doctor before trying manual treatment for a herniated disc.
If manipulation leads to increased pain or new pain in the legs or anywhere else, do not continue this treatment.
Practises to look for in a spinal manipulative therapy practitioner:
- Is willing to coordinate treatment with your other health professional(s)
- Provides educational information about home treatment and exercises
- Diagnoses musculoskeletal problems with physical examination and interview, using X-ray in unusual circumstances
- Is willing to refer you to a specialist when necessary, such as to an orthopedist, neurosurgeon, or oncologist for further testing, or to a registered dietitian for nutritional counselling
- Uses common techniques, such as massage, heat and cold, ultrasound, electric current
- Uses slow, gentle manual therapy technique
Practises to avoid in a spinal manipulative therapy practitioner:
- Uses X-rays as a standard diagnostic test, particularly full-body X-rays or X-rays of children, which give unnecessarily high levels of radiation
- Practises based on the unproven theory that "subluxation" (partial dislocation of two joint surfaces) is responsible for many medical diseases
- Uses joint manipulation to treat such conditions as respiratory and ear infections, skin conditions, eye problems, and learning disabilities
- Promotes long-term spinal manipulative therapy to prevent illness or joint problems
- Sells other products or services, such as herbal or dietary supplements or counselling, without proper training and credentials
If you need more information, see the topic Low Back Pain.
Your Information
Your choices for treating low back pain in the first month are:
- Use home treatment and perhaps work with a physiotherapist for acute low back pain.
- Use home treatment and see a chiropractor, osteopathic doctor, physiatrist, or physiotherapist trained in spinal manipulation.
See your doctor if you have severe or worsening symptoms.
The decision whether to try spinal manipulative therapy for acute low back pain takes into account your personal feelings and the medical facts.
Reasons to try spinal manipulation for acute low back pain
Reasons to not try spinal manipulation for acute low back pain
- You do not have leg pain or numbness.
- You do not have severe pain.
- You know of a reputable practitioner who will coordinate treatment with your other health professional(s).
Are there other reasons you might want to try spinal manipulation?
- You also have leg pain or numbness.
- You have severe pain, and your doctor has not yet ruled out a serious medical cause.
- You are uncomfortable with manual treatments that involve physical contact.
Are there other reasons you might not want to try spinal manipulation?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about using spinal manipulative therapy for low back pain. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
I have low back pain. Yes No Unsure I have tried a few days of home treatment. Yes No Unsure I have low back pain and numbness or pain in my leg. Yes No Unsure I have severe back pain and have not yet had my doctor check it out.
Yes No Unsure I am comfortable with treatment that involves hands-on contact. Yes No Unsure I am familiar with the rare risks of rapid spinal manipulation. Yes No Unsure I have identified a practitioner who has a reputation for being or seems to be ethical. Yes No Unsure The practitioner I've interviewed works according to the 19th-century "subluxation" theory that has no scientific basis. Yes No Unsure The practitioner I've interviewed claims to be able to treat infections or behaviour problems with spinal manipulation. Yes No Unsure The practitioner I've interviewed claims that long-term spinal manipulative therapy maintains good health and prevents health problems. Yes No Unsure Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use chiropractic treatment for acute low back pain.
Check the box below that represents your overall impression about your decision.
Leaning toward using spinal manipulation for acute low back pain
Leaning toward NOT using spinal manipulation for acute low back pain
Return to the topic Low Back Pain.
Other Places To Get Help
Organizations
Canadian Orthopaedic Association 4150 St. Catherine Street West Suite 360 Westmount, QC H3Z 1P4 Phone: (514) 874-9003 Fax: (514) 874-0464 Web Address: http://www.coa-aco.org Canadian Physiotherapy Association 2345 Yonge Street Suite 410 Toronto, ON M4P 2E5 Phone: (416) 932-1888
1-800-387-8679Fax: (416) 932-9708 E-mail: information@physiotherapy.ca Web Address: http://www.physiotherapy.ca
| Author: | Douglas Dana Shannon Erstad, MBA/MPH | Last Updated: April 3, 2006 |
| Medical Review: | William M. Green, MD - Emergency Medicine Tom Bailey, MD - Family Medicine Kathie Hummel-Berry, PT, PhD - Physical Therapy Robert B. Keller, MD - Orthopedics | |
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