Evidence for Chiropractic
There is a range of evidence to indicate that chiropractic care is safe and effective. This evidence includes:
1. UK BEAM Trial Team (2004) United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 329:1377
This recent MRC-funded study estimated the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. All groups improved over time. Exercise improved disability more than "best care" at three months. For manipulation there was an additional improvement at three months and at 12 months. For manipulation followed by exercise there was an additional improvement at three months and at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred.
2. UK BEAM Trial Team (2004) United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care. BMJ 329:1381
Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.
3. European Commission Research Directorate General (2004) European Guidelines for the management of acute non-specific low back pain in primary care
Summary of recommendations for treatment of acute non-specific low back pain:
Give adequate information and reassure the patient
Do not prescribe bed rest as a treatment
Advise patients to stay active and continue normal daily activities including work if possible
Prescribe medication, if necessary for pain relief; preferably to be taken at regular intervals; first choice paracetamol, second choice NSAIDs
Consider adding a short course of muscle relaxants on its own or added to NSAIDs, if paracetamol or NSAIDs have failed to reduce pain
Consider (referral for) spinal manipulation for patients who are failing to return to normal activities
Multidisciplinary treatment programmes in occupational settings may be an option for workers with sub-acute low back pain and sick leave for more than 4 - 8 weeks
4. European Commission Research Directorate General (2004) European Guidelines for the management of chronic non-specific low back pain in primary care (2004)
Manipulation/mobilisation - Summary of the evidence:
There is moderate evidence that manipulation is superior to sham manipulation for improving short-term pain and function in chronic low back pain (CLBP)
There is strong evidence that manipulation and GP care/analgesics are similarly effective in the treatment of CLBP
There is moderate evidence that spinal manipulation in addition to GP care is more effective than GP care alone in the treatment of CLBP
There is moderate evidence that spinal manipulation is no less and no more effective than physiotherapy/exercise therapy in the treatment of CLBP
There is moderate evidence that spinal manipulation is no less and no more effective than back-schools in the treatment of CLBP
Recommendation: Consider a short course of spinal manipulation/mobilisation as a treatment option for CLBP.
5. Effectiveness of Manual Therapies – The UK Evidence Report
This review, by Gert Bronfort et al, was published in the journal Chiropractic & Osteopathy in 2010. Commentaries by Professor Scott Haldeman and Professor Martin Underwood accompany the report. In summary, the report demonstrates robust randomised controlled trial (RCT) evidence that the care offered by chiropractors is effective for a wide range of conditions including neck pain, pain associated with hip and knee osteoarthritis and some types of headache.
6. Review of Manual Therapy Evidence
In 2011, the RCC commissioned a review of manual therapy evidence by Warwick University (‘the Warwick Review’) in order to confirm and update a similar review presented in the UK evidence report (see 6 above) and to extend the range of evidence considered to include non-randomised studies. Compared to the UK evidence report, ratings changed in a positive direction from inconclusive to moderate (positive) evidence ratings in three cases: manipulation/mobilisation [with exercise] for rotator cuff disorder, spinal mobilisation for cervicogenic headache and mobilisation for miscellaneous headache. New moderate (positive) evidence was identified for soft tissue shoulder disorders using myofascial treatments not reported in the UK evidence report. In addition, evidence was identified on a large number of non-musculoskeletal conditions that had not previously been considered by Bronfort, most of this evidence was rated as inconclusive; although moderate (positive) evidence was identified for the use of massage for cancer care
7. Low back pain and sciatica in over 16s: assessment and management
NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. Its guideline on the management of adults and over 16s with back pain and sciatica was published in November 2016.
The evidence-based recommendations include the following:
Provide people with advice and information, tailored to their needs and capabilities, to help them self-manage their low back pain with or without sciatica.
Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica.
Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica.
Consider psychological therapies using a cognitive behavioural approach for managing low back pain with or without sciatica