Acute Back Pain: Spine Therapy No Help
Study: Spinal Manipulation No Help for Acute Low Back Pain
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Spinal Manipulative Therapy for Low Back Pain continued...
"I don't think the results of this study are all that surprising," Chou tells WebMD. "Most people are going to get better on their own after 30 days. People always wonder how well it works to add one treatment on top of another. But that hasn't been shown to work for nearly anything used to treat acute lower back pain."
Chou and colleagues recently updated treatment guidelines for low back pain. After reviewing all the evidence, they made a "weak" recommendation that spinal manipulation may be considered for the treatment of acute low back pain.
"The evidence was not real strong. We give it a weak recommendation because the benefit is not great -- only 10 points on a 100-point pain scale," Chou says.
Spinal Manipulation: Different Practitioners, Different Techniques
Exactly what is spinal manipulative therapy? The techniques used in the study call for therapists to move a patient's joints beyond the normal range of motion. This can be done with slow movements -- what physiotherapists call spinal mobilization -- or with more rapid movements, called spinal manipulation. Most chiropractors use this latter form of spinal manipulative therapy.
In the Hancock study, physiotherapists chose the form of spinal manipulative therapy they thought best for individual patients. Most of the patients in the study got the slower "spinal mobilization" form of treatment.
"The problem is, we don't have good evidence on what is the best technique," Chou says. "A lot of this depends on the provider, and the training is a lot different from country to country and from discipline to discipline. Few studies have compared one technique to another. And if you look at how effective they are against sham treatment or no treatment, they all look about the same."
This doesn't mean that spinal manipulation -- or massage, which uses different techniques -- doesn't help some patients.
"Our advice is if someone is appropriately trained to give it, it should be fine," Chou says. "Manipulation of the lower back is relatively safe. The cervical spine [in the neck region] is more complicated, and that is where there have been problems."
Hancock and colleagues report their findings in the Nov. 10 issue of The Lancet.