Josephine P. Briggs, M.D.
The Evidence for Spinal Manipulation and Low-Back Pain
We know that complementary health approaches are often used to manage symptoms of an underlying disease or condition, such as neck or back pain, or arthritic or musculoskeletal pain—usually along with conventional treatments. Back pain, in particular, is the most common condition for which adults turn to complementary health practices. And it continues to be an important area of focus of NCCAM’s research.
If you have ever suffered from back pain, you know how debilitating it can be. Back pain is a common condition—affecting 8 out of 10 people at some point in their lives—and a topic I’ve talked about more than once in previous messages. As a leading cause of work-related disability in the United States, back pain is a symptom that really matters and is a major public health concern.
Often patients try different approaches, sometimes in consultation with a provider and sometimes on their own, as they search for helpful strategies. Most acute low-back pain (the lower back is the area most often affected) usually improves with self-care practices—things like applying heat to the affected area, using a firm mattress, doing back exercises, or taking pain-relieving medications.
The evidence on use of complementary health approaches in treating low-back pain is growing. For example, studies have shown that spinal manipulation is another option that can provide some people with acute back pain with mild-to-moderate pain relief. Spinal manipulation appears to work about as well as these other treatment approaches. In 2007, the American College of Physicians and the American Pain Society (ACP/APS) issued a joint clinical guideline that included spinal manipulation as one of several complementary treatment options for practitioners to consider when low-back pain does not improve with self-care and becomes chronic. Clinical practice guidelines such as the ACP/APS recommendation represent the top of the evidence-based medicine hierarchy.
For more information on the scientific evidence and other reviews of research on spinal manipulation, check out our updated fact sheet, Spinal Manipulation for Low-Back Pain. As always, I encourage you to talk with your health care providers if you are considering any complementary health practice, including spinal manipulation. It helps ensure that you receive coordinated and safe care. Be well!