﻿In this video, we’ll be taking a look at
two studies on the effectiveness of Spinal Manipulative Therapy for lower back pain.
Let’s define Spinal Manipulative Therapy (SMT). It is a technique of using the hands or a device
to apply a controlled thrust to a joint of your spine. It is performed by chiropractors,
osteopathic physicians, and physical therapists.
Spinal Manipulation was theoretically designed to relieve pressure on the joints, reduce inflammation,
and improve nerve function. To use everyday words, we crack your back to make it feel better.
The first study from 2013 examined over 2000 participants with low back pain who had received
Spinal Manipulation and compared it with known inactive treatments. Specifically, the researchers
were interested in comparing the effectiveness of the different treatments on pain,
function, perceived recovery, return-to-work, and quality of life over the course of one month,
3-6 months, and 12 months.
The results show low-quality evidence of no difference in the effect of Spinal Manipulation compared with
inactive therapy, or sham Spinal Manipulation. Sham Spinal Manipulations acts as the placebo or inactive treatment in the
experiment. I go over the placebo effect in a previous video if you want to check it out.
Links will be provided in the description box below.
It was expected that the effect of Spinal Manipulation would be greater than that of exercise or physical therapy.
Unfortunately, the results did not support that conclusion. To be fair, it is important
to note that the quality of evidence from the majority of the studies was poor,
which was likely a result of the small sample size and the required conditions.
Although the researchers in this 2013 study lacked access to quality evidence, they
conclude that the more pertinent question now is not will Spinal Manipulation help alleviate my low back pain
but rather how can I prevent low back pain?
A similar study conducted in 2019 with over 9000 participants supported the same conclusions
made in the 2013 study. That is, Spinal Manipulation produces similar effects to recommended therapies for low
back pain. This study did find evidence that showed Spinal Manipulation as more effective than
non-recommended interventions for improvement in function in the short term.
Based on current science, there are alternatives to Spinal Manipulation for low back pain
which may be more affordable and are readily available for patients. Some studies list Spinal Manipulation
as a cost-effective option for the treatment of low back pain but this conclusion was based
on only a handful of studies that did not conduct thorough economic evaluations.
For Spinal Manipulation, a licensed professional needs to be present to administer the proper technique.
This hands-on treatment of the spine includes both manipulation and mobilization.
The former is a passive technique where the therapist applies a directed force at or near
the end of the passive range of motion. This is that crack sound when you are manipulated.
For physical therapy, the therapist provides the equipment or guidance as necessary.
They may provide a set of stretching exercises
and provide the patient with electrical stimulation or ice packs to soothe the muscles.
Similarly, yoga and other at-home exercises may require an instructor or trainer
but there’s a vast library or resources found online as well. This may require
more diligence on the patient’s part but is by far the most accessible and affordable option.
The good news is that people who suffer from back pain have options, and can choose between Spinal Manipulation,
physical therapy, and home exercises. It will all depend on your need for guidance,
your discipline in performing those treatments,
and the size of your pocketbook. Until next time, this is Dr. Shim.