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Evidence of benefits from spinal therapy.
Many of the studies that look at the effects of manipulation of the spine focus on the pain relief aspect of care. The results generally indicate that it is of similar benefit to standard medical care.
From a patient point of view this can make chiropractic care seem like an expensive option considering that standard care provides pain relief as well. The benefits of chiropractic care, such as less aggravation in the long term, improved lifestyle habits, or sense of well being, are not investigated as thoroughly because they more difficult to objectively quantify. The science requires us to test ideas in a repeatable, methodical fashion. The bigger picture in commonly lost in the detail.
Many of the researchers assess what they call manipulation. Chiropractic adjustments are very different from mobilisation, and manipulation techniques used by physiotherapists. Even within the chiropractic profession there are many different approaches to addressing spinal joints and extremities.
The truth is we are in the very early days of good quality research into all aspects of musculoskeletal medicine. The process of determining which techniques and approaches are best for patients is being placed under the microscope.
In the last 5 to 10 years chiropractic researchers are now more able to access funding, and support, to conduct studies that observe and explain the results seen in a clinical setting. The profession is striving to do the research and expand the utilisation of chiropractic care to meet the demands of our modern evidence-based world.
The review below gave some support for spinal manipulation for low back pain.
Efficacy of spinal manipulation and mobilisation for low back pain: a systematic review and best evidence synthesis. Spine Journal. 2004 May-Jun;4(3):335-56
The following review, in the same year, reported no more benefit from spinal manipulation than other interventions such as analgesics, GP advice, back school etc.
Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004;(1):CD000447.
Ernst has produced several papers referred to as systematic reviews which question the safety of cervical spine manipulation. He is concerned that without clear evidence of benefit, the apparent low risk rate leads to a conclusion that cervical spinal adjustments should be avoided.
Haldeman has calculated the risk to be very small and random.
A 2008 Canadian review compared stroke rate associated with chiropractors and primary care physicians, as the last clinicians seen prior to the event, and found no difference between the two.
Other research has suggested that adverse reactions will be avoided by using mobilisation rather than manipulation. Spine 2005 Jul1;30(13):1477-84