Chiropractic Management of Low Back Pain and Low Back-Related Leg Complaints: A Literature Synthesis

Received 25 April 2008; received in revised form 3 June 2008; accepted 8 September 2008.

Abstract

Objectives

The purpose of this project was to review the literature for the use of spinal manipulation for low back pain (LBP).

Methods

A search strategy modified from the Cochrane Collaboration review for LBP was conducted through the following databases: PubMed, Mantis, and the Cochrane Database. Invitations to submit relevant articles were extended to the profession via widely distributed professional news and association media. The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input.

Results

A total of 887 source documents were obtained. Search results were sorted into related topic groups as follows: randomized controlled trials (RCTs) of LBP and manipulation; randomized trials of other interventions for LBP; guidelines; systematic reviews and meta-analyses; basic science; diagnostic-related articles, methodology; cognitive therapy and psychosocial issues; cohort and outcome studies; and others. Each group was subdivided by topic so that team members received approximately equal numbers of articles from each group, chosen randomly for distribution. The team elected to limit consideration in this first iteration to guidelines, systematic reviews, meta-analyses, RCTs, and coh ort studies. This yielded a total of 12 guidelines, 64 RCTs, 13 systematic reviews/meta-analyses, and 11 cohort studies.

Conclusions

As much or more evidence exists for the use of spinal manipulation to reduce symptoms and improve function in patients with chronic LBP as for use in acute and subacute LBP. Use of exercise in conjunction with manipulation is likely to speed and improve outcomes as well as minimize episodic recurrence. There was less evidence for the use of manipulation for patients with LBP and radiating leg pain, sciatica, or radiculopathy.

Key Indexing Terms: Low Back Pain, Manipulation, Chiropractic, Spine, Sciatica, Radiculopathy, Review, Systematic

a Senior Director, Center for Teaching and Learning, Palmer College of Chiropractic, Davenport, Iowa

b President, Palmer College of Chiropractic-West, San Jose, Calif

c Private Practice, Minneapolis, Minn

d Vice President for Research, Northwestern Health Sciences University, Bloomington, Minn

e Private Practice, Oregon, Ill

f Dean of Research, Western States Chiropractic College, Portland, Ore

g Professor, Palmer College of Chiropractic-West, San Jose, Calif

h Adjunct Professor, Georgetown University School of Medicine, Washington, DC

i Clinical Professor, Palmer College of Chiropractic-West, San Jose, Calif

j Associate Medical Director for Chiropractic, Department of Labor and Industry, Olympia, Wash

k Professor, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada

l Vice President of Research and Scholarship, Cleveland Chiropractic Research Center, Kansas City, Mo

m Vice President of Research and Scholarship, Cleveland Chiropractic Research Center, Los Angeles, Calif

Submit requests for reprints to: Dana J. Lawrence, DC, MMedEd, Senior Director, Center for Teaching and Learning, Palmer College of Chiropractic, Davenport, IA.

All authors participated without compensation from any organization. There were no declared conflicts of interest.

PII: S0161-4754(08)00277-7

doi:10.1016/j.jmpt.2008.10.007

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