Spinal manipulation as a treatment for musculoskeletal complaints has been practiced for centuries. In the last 50 years, the use of spinal manipulation has been equated with the practice of chiropractic, and, in part because of this, the use of spinal manipulation has been labeled an unorthodox treatment by the medical profession. Recent research favorable to the chiropractic treatment of patients with low-back pain along with the current emphasis on patient outcomes, has helped stimulate a re-appraisal of the role of spinal manipulation. In this article, reprinted from Annals of Internal Medicine, the authors review the scientific literature on the use, complications, and efficacy of spinal manipulation for low back pain. Techniques for spinal manipulation can be broadly categorized as one of two types: nonspecific long-lever manipulations and specific, short-lever, high-velocity spinal adjustments. Long-lever manipulations use the femur, shoulder, head, or pelvis to manipulate the spine in a nonspecific manner, whereas short-lever spinal adjustments use a specific contact point on a process of a vertebra to affect a specific vertebral joint. It is this second method that is most closely identified with chiropractic practice. This article examines the use of lumbar spine manipulation of all types to treat low-back pain, and concludes that spinal manipulation is of short-term benefit in some patients, particularly those with uncomplicated, acute low-back pain, but that data are insufficient concerning the efficacy of spinal manipulation for chronic low-back pain.
Originally published in: Annals of Internal Medicine, v. 117, no. 7, October 1, 1992, pp. 590-598.
This report is part of the RAND Corporation Reprint series. The Reprint was a product of the RAND Corporation from 1992 to 2011 that represented previously published journal articles, book chapters, and reports with the permission of the publisher. RAND reprints were formally reviewed in accordance with the publisher's editorial policy and compliant with RAND's rigorous quality assurance standards for quality and objectivity. For select current RAND journal articles, see External Publications.
Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/research-integrity.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.