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Evidence

There is good evidence that chiropractic can be effective in the treatment of low back pain:

1. 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.

2. NICE (2006) IPG 183 - Non-rigid stabilisation techniques for the treatment of low back pain – guidance

Chiropractic intervention and posture training can limit episodes of acute pain. Spinal rehabilitation, which may include components such as education, lifestyle change, weight loss, general fitness and specific low-back training exercises, may be required.

3. Department of Health (2006) Musculoskeletal Services Framework

“Chiropractors provide evidence-based, timely and effective assessment, diagnosis and management of certain musculoskeletal disorders.”

“The Framework describes a system that enables health and social care professionals to provide more easily a high-quality service to patients. A balanced, well-planned system achieves that, and helps professionals to:

• treat patients at the appropriate point in the system (closer to home or work);
• provide patients with better information to manage their condition, reducing avoidable admissions;
• plan/manage patient flows through primary and secondary care, ensuring appropriate and timely referral to specialist care services;
• develop capacity in primary care by offering a wider range of non-surgical alternatives, eg specialist practitioners, physiotherapy, podiatry, nursing, pain management advice, chiropractic, osteopathy etc.”

4. Low back pain: early management of persistent non-specific low back pain

NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. Its guideline on the acute management of patients with chronic low back pain was published in May 2009.

The evidence-based recommendations include the following:

• Provide people with advice and information to promote self-management of their low back pain.
• Consider offering a course of manual therapy including spinal manipulation of up to 9 sessions over up to 12 weeks
• Consider offering a course of acupuncture needling comprising up to 10 sessions over a period of up to 12 weeks
• Consider offering a structured exercise programme tailored to the individual.

Chiropractors are trained to treat musculoskeletal disorders throughout the body in children and adults. There are no randomised double blind trials to show that that chiropractic can or cannot effectively treat anything other than back pain. There is a large amount of anecdotal evidence to show that chiropractic and craniosacral therapy can be effective in treating many musculoskeletal conditions. This is primarily in the form of word of mouth from chiropractors and their patients. The profession is seeking to improve its research database in these areas.