Spine Journal endorses manipulation over physical therapy for LBP


A January 2018 systematic review of 51 studies examined the efficacy, effectiveness, and safety of various mobilization and manipulation therapies for the treatment of chronic low back pain. The authors concluded: 

“There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe.” (1)

The study also measured manipulation against other widely prescribed options: 

Subgroup analyses showed that manipulation significantly reduced pain and disability, compared with other active comparators including exercise and physical therapy.” 

This analysis reinforces the recent LBP clinical practice guideline from the American College of Physicians recommending that physicians prescribe non-pharmacologic treatment including spinal manipulation, heat, massage, and acupuncture. (2)

As evidence-based providers, we continually assimilate new research with clinical experience. We should also recognize that our clinical experiences are sometimes clouded by habitually seeing the other profession’s failures since successfully managed patients don’t often seek supplementary consult. Evidence-based practice requires that we allow consensus evidence to guide our management decisions without anecdotal bias. 





1. Coulter ID. et al. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. 2018 Jan 31. pii: S1529-9430(18)30016-0.  Spine Journal. doi: 10.1016/j.spinee.2018.01.013. [Epub ahead of print]

2. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. [Epub ahead of print 14 February 2017] 


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s