Effectiveness of manual therapies: the UK evidence report. For instance, the authors write that SMT is effective but “similar in effect to other commonly used efficacious therapies such as usual care, exercise, or back school.” Unfortunately, “back school” is not exactly well known for curing low back pain.
Together, the Bronfort and Rubinstein reviews make it clear that spinal manipulative therapy is probably only of minor clinical value, at best. Summary: A systematic review of systematic reviews published between 20, based on 16 studies that met the criteria.
Research on spinal manipulation is inherently difficult, because double blind studies are impossible and even single blind studies are problematic; a placebo response is hard to rule out.
There is good evidence that spinal manipulation therapy (SMT) is effective for some patients with low back pain but that it is not superior to other treatments.
They explain to clinicians why they should still refer patients for SMT (“preferences” and “costs”); they say that more research is needed to “examine specific subgroups.” (This is based on the rather faint hope that SMT might work so well for an unknown subcategory of patients that they can pull up the average.) And they say there’s a need for “an economic evaluation,” but a treatment cannot be “cost effective” if it is not effective.
The conclusions of this review are also backed up by another major review, the “Bronfort report” on the effectiveness of mannual therapies: Bronfort G, Haas M, Evans R, Leininger B, Triano J. This review of all manual therapies focusses mainly on spinal manipulative therapy and massage therapy for low back and neck pain, with underwhelming results: both are “effective” in some circumstances but certainly not impressively so, and generally no different from other therapies that help a little but haven’t exactly put a dent in the epidemic.Although a bit of a moving target over the years, subluxation theory generally refers to idea that spinal joint dysfunctions have broad health significance, which has been a major component of chiropractic thought since the founding of the profession (see Homola, Subluxation Theory: A Belief System That Continues to Define the Practice of Chiropractic). Harriet Hall in The End of Chiropractic, one of the most commented-on posts from that year: Timothy A. Wyatt, and Leon Greene analyze the peer-reviewed chiropractic literature in the light of Hill’s criteria, the most commonly used model for evaluating whether a suspected cause is a real cause.They ask whether the evidence shows that chiropractic subluxations cause interference with the nervous system and whether they cause disease.There is no acceptable evidence that chiropractic can improve the many other health problems it claims to benefit, from colic to asthma.There is no evidence to support the practice of adjusting the spines of newborns in the delivery room or providing repeated lifelong adjustments to maintain health or prevent disease.Spinal manipulative therapy for acute low-back pain. If it were possible to report good news about spinal manipulation, it would be in this large Cochrane review of the science.Cochrane Database of Systematic Reviews 2012, Issue 9. Unfortunately, the good news is not here to report.might compete with physiotherapists in terms of treating some back problems, but all their other claims are beyond belief and can carry a range of significant risks.” Mirtz TA, Morgan L, Wyatt LH, Greene L.An epidemiological examination of the subluxation construct using Hill’s criteria of causation. This landmark paper penned by four chiropractors is a strong indictment of a philosophical pillar of their own profession, subluxation theory.Historically, spinal manipulative therapy (SMT, a.k.a. chiropractic adjustment) for acute low back pain has been regarded as the best example of evidence-based care routinely offered (primarily) by the chiropropractic profession.Even many fierce critics of chiropractic have supported this claim (or at least left it alone while focusing on other issues, e.g. Nevertheless, critics have pointed out that even this “best” use of SMT has been damned with faint praise by the research.