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30-04-2012 | Sports medicine | Article

Spinal manipulation may offer hope to low back pain patients


Free abstract

MedWire News: Findings from a systematic review suggest that high-velocity low-amplitude spinal manipulation (HVLA SM) is an effective treatment option for low back pain (LBP).

But the authors warn that "the heterogeneity and inconsistency in reporting within the studies reviewed makes it difficult to draw definitive conclusions."

Christine Goertz (Palmer College of Chiropractic, Davenport, Iowa, USA) and colleagues say that the inconsistencies observed between the different studies may be due, in part, to differing SM methods and a lack of standardization of LBP patient types included in the studies.

They therefore advise: "These are issues that should be addressed by the scientific community before future SM studies for LBP are conducted."

The review, published in the Journal of Electromyography and Kinesiology, consisted of 38 studies in which LBP patient outcomes were assessed after HVLA SM.

Outcomes of interest included self-reported pain scores assessed via visual analog scale (VAS) and numerical pain rating scale (NPRS). Self-reported disability secondary to LBP was assessed by the Roland-Morris Disability Questionnaire (RM) and the Oswestry Low Back Pain Disability Index (OSW) scores.

VAS scores were reported on a scale of 0 to 100, where 0 equalled "no pain" and 100 equalled "worst pain possible." NPRS ranged from 0, which represented "no pain" to 10, which represented "unbearable pain."

Findings showed improvement in pain scores after SM, although no significant difference was observed in pain score improvement with SM compared with other forms of LBP therapy, such as physical therapy or exercise.

RM and OSW scores showed improvement before SM compared with after SM. However, the authors report that the changes seen in the studies did not show much consistency.

Furthermore, "there are too few sham control groups [included in these studies] to draw any conclusions regarding effect sizes of active versus sham study designs," say Goertz et al.

They therefore conclude that "HVLA SM for LBP appears to convey a small but consistent treatment effect at least as large as that seen in other conservative methods of care.

"This finding is similar to that in other systematic reviews of SM of LBP."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Lauretta Ihonor

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