Efficacy of Spinal Manipulative Therapy for Low-back Pain of Less than Three Months’ Duration. Ferreira ML, Ferrera PH, Latimer J, Herbert R, Maher CG. J Manipulative Physiol Ther. 2003 Nov-Dec;26(9):593-601.

Objectives: To review the efficacy of spinal manipulation for low-back pain of less than three months’ duration.

Data sources: Randomized clinical trials on spinal manipulative therapy for low-back pain were identified by searching EMBASE, CINAHL, MEDLINE, and the Physiotherapy Evidence Database (PEDro).

Study Selection: Outcome measures of interest were pain, return to work, adverse events, disability, quality of life, and patient satisfaction with therapy.

Data extraction: Methodological assessment of the trials was performed using the PEDro scale. Trials were grouped according to the type of intervention, outcome measures, and follow-up time. Where there were multiple studies with sufficient homogeneity of interventions, subjects, and outcomes, the results were analyzed in a meta-analysis using a random effects model.

Data synthesis: Thirty-four papers (27 trials) met the inclusion criteria. Three small studies showed spinal manipulative therapy produces better outcomes than placebo therapy or no treatment for nonspecific low-back pain of less than three months’ duration. The effects are, however, small. The findings of individual studies suggest that spinal manipulative therapy also seems to be more effective than massage and short-wave therapy. It is not clear if spinal manipulative therapy is more effective than exercise, usual physiotherapy, or medical care in the first four weeks of treatment.

Conclusions: Spinal manipulative therapy produces slightly better outcomes than placebo therapy, no treatment, massage, and short-wave therapy for nonspecific low-back pain of less than three months’ duration. Spinal manipulative therapy, exercise, usual physiotherapy, and medical care appear to produce similar outcomes in the first four weeks of treatment.

Comment: The question to be answered now is, does the low incidence of adverse reactions and side effects from SM make it a more plausible therapy than other typical medical care regimens?