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Epidemiology: Spinal Manipulation Utilization

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Spinal Manipulation Utilization

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SOURCE:   J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 648–654

Eric L. Hurwitz

Department of Public Health Sciences,
John A. Burns School of Medicine,
University of Hawaii,
M?noa, Honolulu, HI 96822, USA.

The objectives of this article are to

(1)   describe spinal manipulation use by time, place, and person, and

(2)   identify predictors of the use of spinal manipulation.

We conducted a systematic review of the English-language literature published from January 1, 1980 through June 30, 2011. Of 822 citations identified, 213 were deemed potentially relevant; 75 were included after further consideration. Twenty-one additional articles were identified from reference lists. The literature is heavily weighted toward North America, Europe, and Australia and thus largely precludes inferences about spinal manipulation use in other parts of the world. In the regions covered by the literature, chiropractors, osteopaths, and physical therapists are most likely to deliver spinal manipulation, often in conjunction with other conservative therapies.

Back and neck pain are the most frequent indications for receiving spinal manipulation; non-musculoskeletal conditions comprise a very small percentage of indications. Although spinal manipulation is more commonly used in adults than children, evidence suggests that spinal manipulation may be more likely used for non-musculoskeletal ailments in children than in adults. Patient satisfaction with spinal manipulation is very high.

From the Full-Text Article:


Although spinal manipulation has been practiced for thousands of years in several cultures spanning the globe, it is most commonly associated with chiropractic and osteopathy, which originated in the late 1800s in the United States (Pettman, 2007). The purpose of this article is to review the literature on the use of spinal manipulation. Specifically, our objectives are twofold: (1) To describe spinal manipulation use by time (temporal trends), place (geographic distribution), and person (practitioner and patient), and (2) to identify predictors of the use of spinal manipulation.

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For the purpose of this paper, spinal manipulation is defined operationally as manual therapy techniques referred to as ‘‘spinal manipulation’’ or ‘‘spinal manipulative therapy’’ in the literature. These techniques include high-velocity, low amplitude (HVLA) manipulation as well as low-force techniques such as spinal mobilization. Massage and other manual therapy techniques non-specific to the spine are excluded.

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About the Author:

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.

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