Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

Abstract

Spine pain is a highly prevalent condition affecting over 11% of the world's population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative therapy (SMT), the main intervention used by chiropractors and other manual therapists. The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be provided. In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.

Keywords: low back pain; manual therapy; neck pain; placebo; spinal manipulative therapy.

Figure 1

Summary of the studies reviewed on neck pain. This figure summarizes the main findings from the studies presented on the efficacy (compared to inactive controls) and effectiveness of spinal manipulative therapy (SMT) against different comparators for acute and chronic neck pain. The green circles with the positive sign indicate studies reporting pain-related outcomes in favor of SMT against or when added to the comparator. Yellow circles indicate similar effectiveness. Red circles with a negative sign indicate that SMT is inferior or does not add any value to the comparator.

Figure 2

Summary of the studies reviewed on low back pain. This figure summarizes the main findings from the studies presented on the efficacy (compared to inactive controls) and effectiveness of spinal manipulative therapy (SMT) against different comparators for acute and chronic low back pain. The green circles with the positive sign indicate studies reporting pain-related outcomes in favor of SMT against or when added to the comparator. Yellow circles indicate similar effectiveness. Red circles with a negative sign indicate that SMT is inferior or does not add any value to the comparator.