Chiropractic is a health care profession focused the non-surgical treatment of disorders of the nervous system and/or musculoskeletal system. Chiropractors maintain a unique focus on spinal manipulation and treatment of surrounding structures.
Many studies have concluded that manual therapies commonly used by chiropractors are generally effective for the treatment of lower back pain (1-2), as well as for treatment of lumbar herniated disc for radiculopathy (3-4) and neck pain, among other conditions (5). When patients with non-specific chronic low back pain are treated by chiropractors, the long-term outcome is enhanced by obtaining maintenance spinal manipulation after the initial intensive manipulative therapy (6).
Fundamentally, chiropractic usually involves treatment of common lower back pain conditions through spinal manipulation, manual manipulation and mobilization (7).
Spinal and manual manipulation refers to a high-velocity, short lever arm thrust that is applied to abnormal vertebra (see Subluxation) with the goal of improving functionality, reducing nerve irritability and restoring range of motion in the back. It is also commonly known as “chiropractic adjustment“. This adjustment can be done either manually by hand or supportive device like a Drop-Piece chiropractic table or Chiropractic Activator Tool. In contrast, Chiropractic mobilization (7) refers to low velocity manipulation, movement and stretching of the muscles and joints, with the goal of increasing the range of motion within those areas. Mobilization is commonly used in addition to chiropractic adjustments.
There is firm literature support for chiropractic treatment of lower back pain. Many of the published guidelines recommend chiropractic manipulation to be included in the treatment plan early in the care of lower back pain (8-16).
Goal setting for the chiropractic treatment plan is driven by the patient’s pain and disability issues and activity intolerance. Consistent among all guidelines of low back pain treatment is the prevention of chronicity. The use of active care (care that is patient-driven such as exercise, activity modification, ergonomic modifications, etc.) is emphasised to accomplish this goal.
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- Rubinstein SM, van Middelkoop M, et. al, “Spinal manipulative therapy for chronic low-back pain,” Cochrane Database Syst Rev (2): CD008112. doi:10.1002/14651858.CD008112.pub2. PMID 21328304.
- Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (2010), “NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain,” Spine J 10 (10): 918–940. doi:10.1016/j.spinee.2010.07.389. PMID 20869008.
- Leininger B, Bronfort G, Evans R, Reiter T, “Spinal manipulation or mobilization for radiculopathy: a systematic review,” Phys Med Rehabil Clin N Am 22 (1): 105–25 (2011). doi:10.1016/j.pmr.2010.11.002. PMID 21292148.
- Hahne AJ, Ford JJ, McMeeken JM, “Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review,” Spine 35 (11): E488–504 (2010).
- Bronfort G, DC, PhD, et al. “Effectiveness of manual therapies: the UK evidence report,” Chiropractic & Osteopathy 2010, 18:3.
- Senna, MK, Machaly SA, “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” Spine 36(18):1427-1437 (2011).
- Globe G, Morris C, Whalen W et al., “Chiropractic Management of Low Back Disorders: Report from a Consensus Process,” Journal of Manipulative and Physiological Therapeutics, November/December 2008: 651-658.
- Bigos S, Bowyer O, Braen G et al., “Acute low back problems in adults. Clinical practice guideline No. 14. AHCPR Publication No. 95-0642,” (1994), Rockville, MD; Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services.
- Meade TW, Dyer S, et al., “Low back pain of mechanical origin: Randomized comparison of chiropractic and hospital outpatient treatment,” Br Med J, 1990; 300:1431-37.
- Meade TW, Dyer S, et al., “Randomized comparison of chiropractic and hospital outpatient management for low-back pain: Results from extended follow-up,” Br Med J, 1995; 311:349-351.
- “Complementary Medicine: New Approaches to good practice,” British Medical Assoc, 1993; Oxford Univ Press, 138.
- Manga P, Angus D et al., “The effectiveness and cost-effectiveness of chiropractic management of low-back pain,” Pran Manga and Associates, University of Ottawa, Canada.
- Rosen M Breen A et al., “Management guidelines for back pain, Appendix B in Report of a clinical standards advisory group committee on back pain,” Her Majesty’s Stationery Office (HMSO), London (1994).
- Shekelle PG, Adams AH et al., “The appropriateness of spinal manipulation for low back pain: Indications and ratings by a multidisciplinary expert pane,” RAND, Santa Monica, CA. Monograph No. R-4025/2 – CCR/FCER (1991).
- Kews BW, Bouter LM, et al.,” Randomized clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: Results of one year follow up,” British Medical Journal, 1992; 304:601-605.
- MacDonald MJ, Morton L, “Chiropractic evaluation study task III report, report of the relevant literature,” MRI Project No. 8533-D, for Department of Defense, OCHAMPUS, Aurora, Colorado, 24 January 1986.