Clinical Effectiveness and Efficacy of
Chiropractic Spinal Manipulation for Spine Pain
Frontiers in Pain Ressearch 2021 (Oct 25); 2: 765921 ~ FULL TEXT
For the management of LBP, most guidelines recommend SMT, with some discrepancies regarding the circumstances in which it should be administered. [19, 125] For example, the United Kingdom's National Institute for Health and Care Excellence (NICE) guidelines make it imperative that SMT be offered alongside exercise therapy for LBP irrespective of the stage.  In contrast, the American College of Physicians' guidelines endorse SMT as a frontline non-invasive intervention, partly because patients with acute LBP improve over time regardless of treatment.  Specifically, for acute stages with or without radiculopathy, clinical practice guidelines recommend the addition of SMT to education, advice to remain active, and self-management. [112, 114, 116] For chronic LBP, the guidelines tend to recommend the use of SMT either alone or preferably in combination with other approaches (frequently second to advice, education, and reassurance) for patients with or without leg pain. [114, 115] Recently, a decision aid developed for managing chronic back pain by Canadian colleges of family physicians endorsed exercise and SMT as the only interventions for which benefits likely exceed harms.  For low- and middle-income countries, the Global Spine Care Initiative produced guidelines taking into consideration practical aspects such as cost.  Their recommendations are to consider the use of manual therapy (SMT and mobilizations) as one of the primary treatment options in patients with both acute and chronic spine pain and SMT specifically for radicular pain.