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Spinal manipulation benefits limited

Spinal manipulation is no more effective than other interventions, such as physiotherapy or exercise, in treating acute low back pain, according to a new Cochrane review.

Pain at one month was 0.2 points lower on the visual analogue scale for spinal manipulation compared with other interventions, but this was not a clinically relevant effect.

Functional status at one week, as measured by a questionnaire, was a clinically irrelevant 0.07 points higher in the spinal manipulation participants than those who underwent other interventions. 

At one month, spinal manipulation was associated with a 0.1 point improvement in functional status, but again the effect was not clinically relevant.

The review looked at 16
randomised controlled trials with a total of 2,674 patients aged 18 or over. All had acute low back pain of less than six weeks’ duration.

The technique was also compared to a sham technique of non-targeted manipulation – and no significant difference in outcomes was seen. 

Study lead Dr Sidney Rubinstein, a senior researcher at the Institute for Health and Care Research at the University of Amsterdam, said: ‘No strong recommendations can be made for the use of spinal manipulation for acute low back pain.’

Cochrane 2012, online 12 September

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