Don’t Crack the Back? No Benefit of Chiropractic for Low Back Pain

Source: Hsieh CY, et al. Effectiveness of four conservative treatments for subacute low back pain. Spine. 2002;27: 1142-1148.

This randomized, assessor-blinded clinical trial was designed to investigate the effectiveness of 3 manual treatment regimens (joint manipulation, myofascial therapy, or a combination of these 2) vs. a back education program. Two hundred patients were assigned to 1 of the 4 groups, with assessments at baseline, every 3 weeks, and at 6 months after the completion of therapy. The primary outcome measures used visual analog scales and Roland-Morris activity scales.

Commentary

All 4 groups showed equal improvement in pain and activity scores after 3 weeks of treatment, and had no further benefit at the 6-month follow-up assessment. There was no significant difference between outcomes using chiropractic treatments as compared to the back education school. Given that back pain is such a large issue in neurology, costing hundreds of millions for the health economy, it is hoped that such well-designed studies will provide evidence-based medicine to guide rational health care and eliminate unhelpful chiropractic methods. —Brian R. Apatoff

Dr. Apatoff, Associate Professor of Neurology, New York Presbyterian Hospital-Cornell Campus, is Assistant Editor of Neurology Alert.