Is Spinal Manipulation an Effective Treatment for Back Pain?

Manipulation has been employed in the treatment of back pain since the time of Hippocrates, who has been referred to as the father of western medicine.  Spinal manipulation involves the application of passive forces to the spine by a healthcare practitioner for the purpose of relieving pain and improving function. Chiropractors, physical therapists, osteopaths, and some medical providers perform spinal manipulation.

There is perhaps no other conservative treatment for back pain that has undergone more research than manipulation. So what can we conclude from this research? Overall, science supports the effectiveness of manipulation in providing moderate relief of low back pain. It tends to be more effective in acute back pain, and when pain is localized to the spine. It has been found to be as effective as medication in reducing back pain. It is also considered safe, with few adverse effects reported in the literature. It can therefore be considered a safe alternative to typical medical management of back pain.

Manipulation is not necessarily more effective than other conservative treatments for back pain, such as exercise or massage. However, most importantly, it has been found to be most effective when used in conjunction with other conservative treatments.

The appropriateness of manipulation for any individual person with spine pain should be determined based upon a thorough physical examination. Physical therapists are qualified to conduct a comprehensive patient evaluation for the purpose of directing optimal management of back pain.  Evidence-based care considers patient values as well in clinical decision-making, therefore the plan of care should reflect a collaboration between the patient and healthcare provider.

Marcia Miller Spoto PT, DC, OCS