Our clinic practices evidence-based healthcare. This means that we use the best available scientific evidence to guide us in our treatments. The following research reviews provide information about current topics related to chiropractic care:
NSAIDs v. Spinal Manipulation
Synopsis. Synopsis. This was a randomized, double-blinded, placebo-controlled, parallel trial to investigate the effectiveness of spinal manipulation compared with nonsteroidal anti-inflammatory drugs (NSAIDs) and with placebo for acute nonspecific low back pain. A total of 101 patients with acute low back pain were recruited. Exclusion criteria were numerous and strict. The subjects were randomized to 3 groups: (1) spinal manipulation and placebo-NSAIDs; (2) sham manipulation and NSAIDs; or (3) sham manipulation and placebo-NSAIDs.
Results. Manipulation outperformed both NSAIDs and placebo. No adverse effects or harm was registered.
Research Quality. Overall, this study had reasonable methodological rigor.
Conclusion. In patients with acute nonspecific low back pain, spinal manipulation was clinically superior to the NSAIDs and clinically superior to placebo.
Comment. This current study was conducted by medical university professors. Spine 2013;38:540-8.
Should You Avoid Spinal Injections?
Synopsis. This was a systematic review to determine the efficacy of epidural corticosteroid injections for sciatica compared with placebo. Two independent reviewers extracted data and assessed risk of bias.
Results. Twenty-five published reports were included. The pooled results showed no clinically important effect of epidural corticosteroid injections compared with placebo for leg pain or disability.
Conclusion. The available evidence suggests that epidural corticosteroid injections are ineffective for patients with sciatica.
Comment. Medical research teams have found no evidence to support the use of injections for the treatment of low back pain or neck pain. Numerous potential adverse reactions have been associated with epidural steroid injections. Although the vast majority of these are minor and transient in nature, serious complications, including nerve damage, paralysis, strokes and death, may also result. In 2012 and 2013 fungal contaminated corticosteroid injections killed 61 people and sickened 749. Additionally, multiple research teams found that epidural corticosteroid injections adversely affect bone mineral density and fracture rate. Annals of Internal Medicine 2012;157:865-77.
Can Chiropractic Benefit Symptomatic Lumbar Disc Herniations?
Synopsis. This was a prospective cohort outcomes study to evaluate patients with low-back pain and leg pain due to MRI-confirmed disc herniation who were treated with chiropractic spinal manipulation. This study included 148 patients (ages 18 to 65 years; acute 53%, subacute 21%, chronic 25%) with low-back pain and leg pain.
Results. Improvement was reported for all outcomes at all time points, but acute patients improved faster. Overall, 90.5% of patients were "improved" at 3 months. For chronic patients, 81.8% were "improved" at 3 months. There were no adverse events reported.
Research Quality. Overall, this study had reasonable methodological rigor.
Conclusion. A large percentage of acute and chronic lumbar disc herniation patients treated with chiropractic spinal manipulation reported clinically relevant improvement.
Comment. The results from this current study are supported by previous research. Journal of Manipulative and Physiological Therapeutics 2014;37:155-63.
Spinal Manipulation Is A Cost-Effective Therapy
Synopsis. This was a systematic review to investigate the cost-effectiveness of spinal manipulative therapy compared to other treatment options for people with spinal pain of any duration. This research team searched eight clinical and economic databases and the reference lists of relevant systematic reviews. Two authors independently screened search results, extracted data and assessed risk of bias.
Results. Six cost-effectiveness and cost-utility analysis studies were included. All included studies had a low risk of bias. Spinal manipulative therapy was found to be a cost-effective treatment to manage neck and back pain when used alone or in combination with other techniques compared to GP care, exercise and physiotherapy.
Research Quality. Overall, this study had very good methodological rigor.
Conclusion. This review supports the use of spinal manipulative therapy in clinical practice as a cost-effective treatment.
Comment. Previous research teams support the findings in this review. Grieves et al. found that chiropractors are less expensive than medical specialists by $300 per case. Nelson et al. showed that chiropractic care lowers health care costs by decreasing the use of expensive technology, surgery and inpatient services. Journal of Electromyography & Kinesiology 2012;22:655-62.
Chiropractic Manipulation in Acute Discogenic Sciatica
Synopsis. One hundred two patients with acute back pain and sciatica with disc protrusion were randomized to active or simulated manipulation. Interventions were done 5 days per week by experienced chiropractors. The number of sessions depended on pain relief, up to a maximum of 20 sessions.
Results. Manipulation compared with placebo 6 months after therapy was 79% better for low back pain and 64% better for leg pain.
Research Quality. Study Quality. Overall, this was a high quality study.
Conclusion. Chiropractic care delivered a very large clinically important pain reduction benefit at six months, and no patient experienced an adverse event.
Comment. Spine Journal 2006;6:131-7.
Physical Fitness Is Valuable
Synopsis. Synopsis. This was a cross-sectional study that examined the relationship between physical fitness and low back pain. This research team analyzed data of 1,723 participants. Physical activity was assessed by questionnaire measuring type of activity, intensity, and time spent on these activities.
Results. Higher levels of physical fitness, both muscular and aerobic, were associated with less low back pain.
Research Quality. Overall, this study had good methodological rigor.
Conclusion. These findings suggest that physical activity is important in the prevention of low back pain.
Comment. The significance of physical activity in the management of low back pain is generally accepted, and the increase or normalization of physical activity levels has become an important recommendation in the management of low back pain. Our clinic assesses the physical performance of patients for both muscle endurance and cardiovascular fitness with a set of validated tests. Based upon a patient’s findings, a specific rehab program is designed to improve any shortfalls. European Spine Journal 2012;21:1265-72.
Spinal Manipulation Is Effective in Chronic Neck Pain
Synopsis. This was a systematic review of randomized clinical trials assessing spinal manipulation in patients with chronic neck pain. Two investigators selected and scored studies using the Cochrane Collaboration Back Review Group for Spinal Disorders list. Two assessors scored studies separately, and disagreements were resolved by consensus.
Results. Results. Clinically important benefit for manipulation was found both short-term (6 weeks) and long-term (2 years). No serious adverse events were reported in the manipulation studies.
Research Quality. Overall, this was a high quality study.
Conclusion. There is evidence that subjects with chronic neck pain show clinically important short- and long-term improvements from a course of spinal manipulation.
Comment. Spinal manipulation should be considered a first-line choice for patients with chronic neck pain. Journal of Manipulative and Physiological Therapeutics 2007;30:215-27.