Benefits and Harms of Spinal Manipulative Therapy for the Treatment of Chronic Low Back Pain: Systematic Review and Meta-Analysis of Randomised Controlled Trials
47 Trials, 9,211 Participants
SOURCE
https://pubmed.ncbi.nlm.nih.gov/30867144/
REFERENCE
16
NICE
REFERENCE
123
organisation
BMJ
TITLE
Benefits and Harms of Spinal Manipulative Therapy for the Treatment of Chronic Low Back Pain: Systematic Review and Meta-Analysis of Randomised Controlled Trials
47 Trials, 9,211 Participants
SOURCE
https://pubmed.ncbi.nlm.nih.gov/30867144/
DISC COMMENTARY
This systematic review and meta-analysis pooled 47 randomised controlled trials with over 9,200 participants, comparing spinal manipulation with other therapies for chronic low back pain. It measured pain and function at 1, 6 and 12 months, and tracked how often manipulation caused harm.
What was studied?
The review compared manipulation against guideline-recommended therapies such as exercise, and against therapies not typically recommended. It also checked how consistently trials recorded adverse events, since only about half tracked side effects systematically.
What did they find?
Against recommended therapies like exercise, manipulation produced broadly similar results, with differences in pain and function often too small to matter clinically. Against non-recommended therapies it showed a real short-term functional benefit, with no increased risk of harm found.
Why it matters
Manipulation performs about as well as other established treatments for chronic back pain, rather than being clearly superior or inferior. That means the choice between reasonable options can come down to preference and practicality.
Why we included it
It shows that good evidence sometimes proves two treatments simply comparable rather than one superior. Combining manual therapy with other elements of care is a reasonable strategy, not a compromise on quality.
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What was studied?
The review compared manipulation against guideline-recommended therapies such as exercise, and against therapies not typically recommended. It also checked how consistently trials recorded adverse events, since only about half tracked side effects systematically.
What did they find?
Against recommended therapies like exercise, manipulation produced broadly similar results, with differences in pain and function often too small to matter clinically. Against non-recommended therapies it showed a real short-term functional benefit, with no increased risk of harm found.
Why it matters
Manipulation performs about as well as other established treatments for chronic back pain, rather than being clearly superior or inferior. That means the choice between reasonable options can come down to preference and practicality.
Why we included it
It shows that good evidence sometimes proves two treatments simply comparable rather than one superior. Combining manual therapy with other elements of care is a reasonable strategy, not a compromise on quality.