Spinal Manipulation for Low-Back Pain
Low-back pain is a
common condition that can be difficult to treat. Spinal manipulation. The application of
controlled force to a joint, moving it beyond the normal range of motion in an effort to aid in restoring
health. Manipulation may be performed as a part of other therapies or whole medical systems, including chiropractic medicine, massage, and naturopathy. is among the treatment options used
by people with low-back pain in attempts to relieve pain and improve functioning. It is
performed by chiropractors and other health care professionals such as physical therapists, osteopaths, and some
conventional medical doctors. This fact sheet summarizes the current scientific knowledge about the effects of
spinal manipulation on low-back pain.
- Evidence indicates that spinal manipulation can provide mild-to-moderate relief from low-back pain. It
appears to be as effective as conventional treatments, and recent guidelines for health care practitioners
include it as a treatment option for pain that does not improve with self-care.
- Spinal manipulation is generally a safe treatment for low-back pain. The most common side effects (e.g.,
discomfort in the treated area) are minor and go away within 1 to 2 days. Serious complications are very
- Recent research into spinal manipulation for low-back pain has begun to look at the effects of different
forms of manipulation, as well as treatment duration and frequency.
- Tell your health care providers about any complementary and alternative practices you use. Give them a full
picture of what you do to manage your health. This will help ensure coordinated and safe care.
About Low-Back Pain
Each year, up to one-quarter of U.S. adults experience low-back pain. Most people have significant back pain at
least once in their lives; often, the cause is unknown. Back pain varies widely. For many people, it lasts only a
few weeks, no matter what treatment is used. But for others, the pain can become chronic and even debilitating.
Low-back pain is a challenging condition to diagnose, treat, and study.
Spinal Manipulation and Low-Back Pain
Spinal manipulation—sometimes called "spinal manipulative therapy"—is practiced by health care professionals such
as chiropractors, physical therapists, osteopaths, and some conventional medical doctors. Practitioners perform
spinal manipulation by using their hands or a device to apply a controlled force to a joint of the spine, moving it
beyond its passive range of motion. The amount of force applied depends on the form of manipulation used. The goal
of the treatment is to relieve pain and improve physical functioning.
In the United States, spinal manipulation is often performed as part of chiropractic care. Chiropractic: A whole
medical system that focuses on the relationship between the body’s structure—mainly the spine—and function.
Practitioners perform adjustments (also called manipulation) with the goal of correcting structural alignment
problems to assist the body in healing. is a health care approach that focuses on the relationship between the
body's structure—mainly the spine—and its functioning. In chiropractic, spinal manipulation is sometimes called
"adjustment." Back problems are the most common reason people seek chiropractic care. (For background information
on chiropractic, see the fact sheet Chiropractic: An Introduction.)
What the Science Says
Study Findings to Date
Overall, studies have shown that spinal manipulation can provide mild-to-moderate relief from low-back pain and
appears to be as effective as conventional medical treatments. In 2007 guidelines, the American College of
Physicians and the American Pain Society include spinal manipulation as one of several treatment options for
practitioners to consider using when pain does not improve with self-care.
Research is under way to determine whether the effects of spinal manipulation depend on the duration and frequency
of treatment. Recent studies have found that spinal manipulation provides relief from low-back pain at least over
the short term (i.e., up to 3 months), and that pain-relieving effects may continue for up to 1 year. In one study
funded by the National Center for Complementary and Alternative Medicine (NCCAM) that examines long-term effects in
more than 600 people with low-back pain, results to date suggest that chiropractic
care involving spinal manipulation is at least as effective as conventional medical care for up to 18 months.
However, less than 20 percent of participants in this study were pain free at 18 months, regardless of the type
of treatment used.
Challenges Facing Researchers
When considering the evidence on spinal manipulation for low-back pain, it is important to know about the research
behind the evidence. Although many clinical trials have been conducted, earlier trials tended to be small and
poorly designed, making their findings less reliable. Moreover, studies have differed in focus (the specific type
of back pain treated and form of manipulation used) and design (comparisons with other treatments vs. placebos). It
can be difficult to clearly interpret findings when what is being measured varies widely from one study to the
next. Recent research has begun to address these issues.
Side Effects and Risks
Common Side Effects
Reviews have concluded that spinal manipulation is relatively safe when performed by a trained and licensed
practitioner. The most common side effects are generally minor and include temporary discomfort in the treated
area, headache, or tiredness. These effects usually go away in 1 to 2 days.
The rate of serious complications from spinal manipulation, although not definitely known, appears to be very
low overall. A potential complication from low-back manipulation is cauda equina syndrome, a condition in which
nerves in the lower part of the spinal cord become compressed, resulting in pain, weakness, and loss of feeling in
one or both legs. Other functions—such as bowel or bladder control—may also be affected. Reports indicate that
cauda equina syndrome is an extremely rare complication. In people whose pain is caused by a herniated disc,
manipulation of the low back also appears to have a very low chance of either causing or worsening cauda equina
Projects supported by NCCAM to study spinal manipulation for low-back pain include studies of:
- The optimal number and frequency of treatments, and the duration of care
- Estimated use, costs, and outcomes of chiropractic care for recurrent back pain
- What happens in the body during manipulation of the low back.
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flexion-distraction with active exercise for chronic low back pain. European Spine Journal.
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