The AHCPR Guideline

The AHCPR and RAND systematic reviews of clinical trials each led to findings and recommendations regarding spinal manipulation. In its spinal manipulation summary, the AHCPR guideline concludes:

• Manipulation can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms. 
  
• When findings suggest progressive or severe neurologic deficits, an appropriate diagnostic assessment to rule out serious neurologic conditions is indicated before beginning manipulation therapy. 
  
• There is insufficient evidence to recommend manipulation for patients with radiculopathy. 
  
• A trial of manipulation in patients without radiculopathy and with symptoms lasting longer than a month is probably safe, but efficacy is unproven. 
  
• If manipulation has not resulted in symptom improvement that allows increased function after 1 month of treatment, manipulation therapy should be stopped and the patient reevaluated.^5(p34) 
  

Regarding the efficacy of spinal manipulation, the RAND publication states:

The literature on the efficacy of spinal manipulation is of uneven quality. While many studies are randomized controlled trials, there is a great diversity in the initial selection and evaluation of patients for study, assignment of those patients to spinal manipulation or a control treatment, the type of spinal manipulation given, the type of control treatment given, and the method of assessing a response. Given that caveat, support is consistent for the use of spinal manipulation as a treatment for patients with acute low-back pain and an absence of other signs or symptoms of lower limb nerve-root involvement. Support is less clear for other indications, with the evidence for some insufficient (acute and subacute low-back pain with sciatica, acute and subacute low-back pain with minor lower limb neurologic findings, most types of chronic low back pain), while the evidence for others is conflicting (acute low-back pain with sciatica and minor lower limb neurological findings, subacute low-back pain without sciatica, and chronic low-back pain without sciatica).^6(pv)

 

In summary, clinical trials of spinal manipulation performed by physical therapists provide the major source of evidence supporting the AHCPR and RAND findings and recommendations. However, three other professions also contributed to that evidence. The multidisciplinary expert panels that produced the AHCPR and RAND documents recognized spinal manipulation to include many different techniques, including both long-lever and short-lever, high-velocity methods. Most importantly, these landmark publications support spinal manipulation as being part of the professional practice of chiropractors, medical doctors, osteopaths, and physical therapists, rather than being the exclusive domain of any of these professions.

For more detailed information regarding this study, click on the link below.

http://ptjournal.apta.org/cgi/content/full/80/8/820