The Appropriateness of Spinal Manipulation for Low-Back Pain

Project Overview and Literature Review

by Paul G. Shekelle, Alan H. Adams, Mark R. Chassin, Eric Hurwitz, Reed B. Phillips, Robert H. Brook


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This report contains a literature review on spinal manipulation treatment for low-back pain, covering the literature from 1955 to 1991, and gathering data from 76 sources, including 22 controlled trials of the use of spinal manipulation for low-back pain. Based on limited data, it is estimated that about 5 percent of the U.S. population uses chiropractors annually. Without systematic reports on the frequency of complications, anecdotal evidence suggests that the serious complications of spinal manipulation include death, paraplegia, and advancement of unrecognized coexisting medical disorders because of misdiagnosis; the rate of these occurrences is probably low. The literature on the efficacy of spinal manipulation is of uneven quality; given that caveat, support is consistent for the use of spinal manipulation as a treatment for patients with acute low-back pain and an absence of other signs of lower-limb nerve-root involvement.

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