We read an interesting summary in the March 2019 edition of BACKspace.
In 2011, we saw the publication of a Cochrane review which peer reviewed high quality research to identify the effect of spinal manipulative therapy (SMT) on chronic low back pain. The review concluded that Spinal Manipulative was as effective as other therapies for chronic lower back pain.
In this month’s BACKspace, Sidney Rubinstein DC PhD summarizes the findings of an update of the same Cochrane review. Dr Rubenstein is one of the chiropractors who have been working on the latest study of robust research articles. For the new review, the Cochrane team highlighted 21 new Randomised Controlled Trials (RCT). RCT are considered to be a very high quality form of research with mechanisms to prevent bias. Dr Rubinstein and his colleagues identified 47 RCTs in total, comprising over 9000 subjects. This was felt to be a large enough study cohort to give a more definitive answer.
The Cochrane team concluded that SMT is no better but no worse than other therapies at achieving a reduction in pain and improvement in function. No difference was identified between the outcomes of different specialties (chiropractic, osteopathy or manual therapy). There was also no difference in outcomes of different methods of SMT (such as high velocity or low velocity mobilisation.
These findings underpin previous evidence that chiropractic is as effective as conventional medical therapies. Dr Rubinstein makes a strong case for the inclusion of SMT in clinical guidelines. Indeed, in 2017, the American College of Physicians included SMT as a treatment option in their clinical guidelines.
Dr Rubinstein concludes that the ultimate goal of any practitioner should be to educate patients in self management of low back pain and mechanisms to improve spinal health.

Rubinstein,S. Research Corner: An update of the Cochrane Review on the effect of spinal manipulative therapy for chronic low-back pain. What does it mean for you? BACKspace, March 2019 p12

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