Spinal Manipulation Therapy for Acute Low Back Pain

The October 2010 issue of The Spine Journal includes a new review of the scientific evidence supporting spinal manipulative therapy (SMT) for low back pain (LBP). The results were quite favorable and reflect a growing body of evidence supporting SMT over medications and other conservative options. SMT research demonstrates “equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up.” The authors conclude by recommending that other health care providers consider SMT as a viable option if self care or education fails to provide pain relief.

METHODS: Literature was identified by searching MEDLINE using indexed and free text terms. Studies were included if they were randomized controlled trials (RCTs) published in English, and SMT was administered to a group of patients with LBP of less than 3 months. RCTs included in two previous SRs were also screened, as were reference lists of included studies. Combined search results were screened for relevance by two reviewers. Data related to methods, risk of bias, harms, and results were abstracted independently by two reviewers.

RESULTS: The MEDLINE search returned 699 studies, of which six were included; an additional eight studies were identified from two previous SRs. There were 2,027 participants in the 14 included RCTs, which combined SMT with education (n=5), mobilization (MOB) (n=4), exercise (n=3), modalities (n=3), or medication (n=2). The groups that received SMT were most commonly compared with those receiving physical modalities (n=7), education (n=6), medication (n=5), exercise (n=5), MOB (n=3), or sham SMT (n=2). Most studies (n=6) administered 5 to 10 sessions of SMT over 2 to 4 weeks for acute LBP. Outcomes measured included pain (n=10), function (n=10), health-care utilization (n=6), and global effect (n=5). Studies had a follow-up of less than 1 month (n=7), 3 months (n=1), 6 months (n=3), 1 year (n=2), or 2 years (n=1). When compared with various control groups, results for improvement in pain in the SMT groups were superior in three RCTs and equivalent in three RCTs in the short term, equivalent in four RCTs in the intermediate term, and equivalent in two RCTs in the long term. For improvement in function, results from the SMT groups were superior in one RCT and equivalent in four RCTs in the short term, superior in one RCT and equivalent in one RCT in the intermediate term, and equivalent in one RCT and inferior in one RCT in the long term. No harms related to SMT were reported in these RCTs.

CONCLUSIONS: Several RCTs have been conducted to assess the efficacy of SMT for acute LBP using various methods. Results from most studies suggest that 5 to 10 sessions of SMT administered over 2 to 4 weeks achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up.

Reference: Dagenais, S; Gay, RE; Tricco, AC; Freeman, MD; Mayer, JM (2010). "NASS Contemporary Concepts in Spine Care: spinal manipulation therapy for acute low back pain.". The spine journal. 10 (10): 918–40.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708

Efficacy of spinal manipulation for chronic cervicogenic headaches

Headaches are among the common complaints in patients presenting for professional care. Patients with headaches often seek chiropractic care because they find spinal manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine is often the origin of the headache as the nerves in the upper neck pass through the thick, overly taught neck muscles in route to the scalp/head. When the muscles of the neck are in spasm, the nerves get irritated or squeezed by the overly tight muscles resulting in headache pain.

A research study published in October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as spinal manipulation therapy (SMT) offers a perfect remedy for patients who doesn't want to utilize medications in the treatment of headaches. Combine SMT with dietary management, lifestyle modifications, stress management, and vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural approach to the management of chronic headaches can be accomplished.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

Chiropractic had the highest perceived benefit for back pain

A study published in the Journal of the American Board of Family Medicine reports on interviews with 31,044 individuals who used complementary and alternative medicine (CAM) for low back pain (LBP). The results are as follows:

The top 6 CAM therapies for LBP, starting with the most-used approaches are: chiropractic, massage, herbal therapy, acupuncture, yoga/tai chi/qi gong, and relaxation techniques.

Chiropractic use (76% of respondents) was larger than all the other 5 therapies combined.

Of those who used CAM modalities for back pain, 27% used it because conventional medicine did not help, 53% used it in conjunction with medical care, and 24% used it because their medical provider recommended it.

Chiropractic users scored the highest on their satisfaction and clinical benefits out of all 6 approaches. This reconfirms earlier findings from the Archives of Physical Medicine & Rehabilitation 2005, which reported that spinal manupulative therapy (SMT) provided the greatest pain relief scoring higher than nerve blocks, opioid analgesics, muscle relaxants, acupuncture, or NSAIDs.

Reference: Kanodia AK, Legedza ATR, Davis RB, et al. Perceived benefit of complementary and alternative medicine (CAM) for back pain: a national survey. J Am Board Fam Med. 2010;23(3):354–362.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

Study Shows Chiropractic Helps Headaches

A study published in the February 2010 issue of The Spine Journal provided additional evidence demonstrating the effectiveness of chiropractic for cervicogenic headaches.

In this study, 80 patients with chronic cervicogenic headaches were divided into three groups. Two of the groups received various forms of chiropractic adjustments, which the study authors called Spinal Manipulative Therapy (SMT), and one group received just a light massage so as to be able to compare the results. Results were calculated using standard pain scales. Data from the subjects was collected every 4 weeks for a 24 week period.

The researchers found that the groups that received chiropractic treatment showed significantly greater improvement in pain scores as compared to the group that got just light massage. Those receiving the chiropractic care were more likely to have a 50-percent improvement in their pain. The two groups of patients who received chiropractic care were only given either 8 or 16 chiropractic sessions. The study did see a slightly better response for the group receiving more adjustments, but due to the study parameters, no data was available beyond 16 visits.

In conclusion it states, “Our pilot study adds to an emerging picture of spinal manipulative therapy dose for the treatment of headache. It showed that a plateau in intervention effect might be found in the range of eight to 16 treatment sessions, although a dose effect at these treatment levels cannot be ruled out. The study also adds to the support of spinal manipulative therapy in moderate doses as a viable option for the treatment of chronic cervicogenic headaches.”

Source: Haas M, Spegman A, Peterson D, Aickin M, Vavrek D. Dose Response and Efficacy of Spinal Manipulation for Chronic Cervicogenic Headache: A Pilot Randomized Controlled Trial. Spine J. 2010(Feb);10(2):117-128.

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic