View Expanded Version of Spinal Manipulation for Low-Back Pain

Spinal Manipulation for Low-Back Pain

© Matthew Lester

Low-back pain is a common condition that can be difficult to treat. Spinal manipulation is among the treatment options used by people with low-back pain in attempts to relieve pain and improve functioning. Spinal manipulation is performed by chiropractors and other health care professionals such as physical therapists, osteopaths, and some conventional medical doctors. This fact sheet from the National Center for Complementary and Alternative Medicine (NCCAM) summarizes the current scientific knowledge about the effects of spinal manipulation on low-back pain.

Spinal Manipulation and Low-Back Pain

Spinal manipulation—sometimes called "spinal manipulative therapy"—is practiced by health care professionals such as chiropractors, physical therapists, osteopaths, and some conventional medical doctors. Practitioners perform spinal manipulation by using their hands or a device to apply a controlled force to a joint of the spine, moving it beyond its passive range of motion. The amount of force applied depends on the form of manipulation used. The goal of the treatment is to relieve pain and improve physical functioning.

In the United States, spinal manipulation is often performed as part of chiropractic care. Chiropractic is a health care approach that focuses on the relationship between the body's structure—mainly the spine—and its functioning. In chiropractic, spinal manipulation is sometimes called "adjustment." Back problems are the most common reason people seek chiropractic care.

What the Science Says

Study Findings to Date

Overall, studies have shown that spinal manipulation can provide mild-to-moderate relief from low-back pain and appears to be as effective as conventional medical treatments. In 2007 guidelines, the American College of Physicians and the American Pain Society include spinal manipulation as one of several treatment options for practitioners to consider using when pain does not improve with self-care.

Research is under way to determine whether the effects of spinal manipulation depend on the duration and frequency of treatment. Recent studies have found that spinal manipulation provides relief from low-back pain at least over the short term (i.e., up to 3 months), and that pain-relieving effects may continue for up to 1 year. In one study funded by NCCAM that examines long-term effects in more than 600 people with low-back pain, results to date suggest that chiropractic care involving spinal manipulation is at least as effective as conventional medical care for up to 18 months. However, less than 20 percent of participants in this study were pain free at 18 months, regardless of the type of treatment used.

Challenges Facing Researchers

When considering the evidence on spinal manipulation for low-back pain, it is important to know about the research behind the evidence. Although many clinical trials have been conducted, earlier trials tended to be small and poorly designed, making their findings less reliable. Moreover, studies have differed in focus (the specific type of back pain treated and form of manipulation used) and design (comparisons with other treatments vs. placebos). It can be difficult to clearly interpret findings when what is being measured varies widely from one study to the next. Recent research has begun to address these issues.

Side Effects and Risks

Common Side Effects

Reviews of research studies have concluded that spinal manipulation is relatively safe when performed by a trained and licensed practitioner. The most common side effects are generally minor and include temporary discomfort in the treated area, headache, or tiredness. These effects usually go away in 1 to 2 days.

Serious Complications

The rate of serious complications from spinal manipulation, although not definitely known, appears to be very low overall. A potential complication from low-back manipulation is cauda equina syndrome, a condition in which nerves in the lower part of the spinal cord become compressed, resulting in pain, weakness, and loss of feeling in one or both legs. Other functions—such as bowel or bladder control—may also be affected. Reports indicate that cauda equina syndrome is an extremely rare complication. In people whose pain is caused by a herniated disc, manipulation of the low back also appears to have a very low chance of either causing or worsening cauda equina syndrome.

Tell your health care providers about any complementary and alternative practices you use, including spinal manipulation. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

NCCAM Research

Projects supported by NCCAM to study spinal manipulation for low-back pain include research on:

• The optimal number and frequency of treatments, and the duration of care
• Estimated use, costs, and outcomes of chiropractic care for recurrent back pain
• What happens in the body during manipulation of the low back.

For More Information

You can learn more about spinal manipulation for low-back pain from NCCAM by viewing the expanded version of this fact sheet at nccam.nih.gov/health/pain/spinemanipulation.htm or ordering a printed version from the NCCAM Clearinghouse. The expanded fact sheet includes selected references and additional resources.

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