Is Spinal Manipulation Effective for Pain? An Overview of Systematic Reviews

Abstract

Collectively, these data fail to demonstrate that spinal manipulation is an effective intervention for pain management.

The Within-Session Change in Low Back Pain Intensity Following Spinal Manipulative Therapy Is Related to Differences in Diffusion of Water in the Intervertebral Discs of the Upper Lumbar Spine and L5-S1

“…12,20,22,50 A large body of research has generally supported efficacy and effectiveness of SMT for the treatment of LBP, with overall effect-size improvements in pain following SMT that are typically modest when compared to placebo treatment or to no treatment at all. 16,19,33,[36][37][38]42,55,59,62 These findings suggest a heterogeneous response between patients receiving SMT. One cause for this variation may be explained by differences in water diffusion within the lumbar IVD.…”

Changes in Pain Perception after Pelvis Manipulation in Women with Primary Dysmenorrhea: A Randomized Controlled Trial

“…SM has been recently described as an ineffective treatment for managing some pain conditions [39]. Nevertheless, as suggested, most studies of SM have failed to either employ CGs with sham intervention or use blinded designs and sample sizes based on power calculations [39]. The present study has controlled these aspects to increase internal validity.…”

Belief reinforcement: one reason why costs for low back pain have not decreased

“…Does the lay public fully appreciate the fact that, for instance, while some 90% of patients with symptoms of low back pain show radiographic evidence of disc pathology, so do 30%–50% of asymptomatic individuals?33,34 What needs to be emphasized is that even if this were the source of their symptoms, it is not alterable in any therapeutically worthwhile way by hands-on or other noninvasive SAB-based treatment (eg, mechanical traction) 35. All stakeholders need to bear in mind that Cochrane review evidence (admittedly less than ideal) currently shows that spinal manipulative therapy is of no or limited benefit for either acute or chronic low back pain 36–38…”