Does Spinal Manipulative Therapy Work for Lower Back Pain?

In this video/blog, we’ll be taking a look at two studies on the effectiveness of spinal manipulative therapy for low back pain. 

Background

let’s define spinal manipulative therapy (SMT). It is a technique  of using the hands or a device to apply a controlled thrust to a joint of your spine. It is performed by chiropractors, osteopathic physicians, and physical therapists. SM was theoretically  designed to relieve pressure on joints, reduce inflammation, and improve nerve function. To use everyday words,  we crack your back to make it feel better.

Comparison of Studies

The first study from 2013 examined over 2000 participants with low back pain who had received SMT , and compared it with known inactive treatments. Specifically, the researchers were interested in comparing the effectiveness of these different treatments on pain, function, perceived recovery, return-to-work and quality of life over the course of one month, 3-6 months, and 12 months. 

The results show low-quality evidence of no difference in effect of SMT compared with inactive therapy, or sham SMT. Sham SMT acts as the placebo or inactive treatment in the experiment. I go over the placebo effect in a previous video if you want to check it out. Links will be provided in the description box below.

It was expected that the effect of SMT would be greater than that of exercise or physical therapy. Unfortunately, the results did not support that conclusion. To be fair, it is important to note that the quality of evidence from the majority of the studies were poor, which was likely a result of the small sample size and the required conditions. 

Although the researchers in this 2013 study lacked access to quality evidence, they conclude that the more pertinent question now is not will SMT help alleviate my low back pain but rather how can I prevent low back pain?

A similar study conducted in 2019 with over 9000 participants supported the same conclusions made in the 2013 study. That is, SMT produces similar effects to recommended therapies for  low back pain. This study did find evidence that showed SMT as more effective than non-recommended interventions for improvement in function in the short term.

Chiropractic care, physical therapy, home exercises

 Based on current science,  there are alternatives to SMT for low back pain  which may be more affordable and are readily available for patients. Some studies list SMT as a cost effective option for the treatment of low back pain but this conclusion was based on only a handful of studies that did not conduct thorough economic evaluations.

What is the bottomline?

For SMT, a licensed professional needs to be present to administer the proper technique. This hands-on treatment of the spine includes both manipulation and mobilization. The former is a passive technique where the therapist applies a directed force at or near the end of the passive range of motion.This is that crack sound when you are manipulated.

For physical therapy, the therapist provides the equipment or guidance as necessary. They may provide a set of stretching exercises and provide the patient with electrical stimulation or ice packs to soothe the muscles.

Similarly, yoga and other at-home exercises may require an instructor or trainer but there’s a vast library or resources found online as well. This may require more diligence on the patient’s part but is by far the most accessible and affordable option. 

The good news is that people who suffer from back pain have options, and can chose between SMT, physical therapy, and home exercises.  It will all depend on your need for guidance, your discipline in performing those treatments, and the size of your pocketbook. Until next time, this is Dr. Shim.

Last modified: August 5, 2021