Spinal manipulation in the treatment of musculoskeletal pain
- Paul Shekelle, MD
Paul Shekelle, MD
- Professor of Medicine
- UCLA Medical School
- Howard Vernon, DC, FCCS (Hons), PhD
Howard Vernon, DC, FCCS (Hons), PhD
- Canadian Memorial Chiropractic College
- Julie M Fritz, PT, PhD
Julie M Fritz, PT, PhD
- Department of Physical Therapy, University of Utah
Spinal manipulation is a technique used by chiropractors, physical therapists, and osteopathic clinicians, primarily to provide relief for musculoskeletal pain related to the back and neck. It has also been used for other conditions, which are discussed briefly below.
This topic will focus on a description of spinal manipulation and a discussion of its effectiveness. Other discussions concerning the treatment of the patient with back and/or neck pain is presented separately:
Subscribers log in hereLiterature review current through: Aug 2017. | This topic last updated: Mar 14, 2016.References
- Millan M, Leboeuf-Yde C, Budgell B, Amorim MA. The effect of spinal manipulative therapy on experimentally induced pain: a systematic literature review. Chiropr Man Therap 2012; 20:26.
- Maigne JY, Vautravers P. Mechanism of action of spinal manipulative therapy. Joint Bone Spine 2003; 70:336.
- Shekelle PG, Brook RH. A community-based study of the use of chiropractic services. Am J Public Health 1991; 81:439.
- Hurwitz EL, Coulter ID, Adams AH, et al. Use of chiropractic services from 1985 through 1991 in the United States and Canada. Am J Public Health 1998; 88:771.
- Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev 2015; :CD004249.
- Bronfort G, Nilsson N, Haas M, et al. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 2004; :CD001878.
- Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study. Am J Public Health 2002; 92:1634.
- Bergman GJ, Winters JC, Groenier KH, et al. Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial. Ann Intern Med 2004; 141:432.
- Balon J, Aker PD, Crowther ER, et al. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. N Engl J Med 1998; 339:1013.
- Gouveia LO, Castanho P, Ferreira JJ. Safety of chiropractic interventions: a systematic review. Spine (Phila Pa 1976) 2009; 34:E405.
- Ernst E. Prospective investigations into the safety of spinal manipulation. J Pain Symptom Manage 2001; 21:238.
- Thiel HW, Bolton JE, Docherty S, Portlock JC. Safety of chiropractic manipulation of the cervical spine: a prospective national survey. Spine (Phila Pa 1976) 2007; 32:2375.
- Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. Spine (Phila Pa 1976) 2005; 30:1477.
- Whedon JM, Mackenzie TA, Phillips RB, Lurie JD. Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine (Phila Pa 1976) 2015; 40:264.
- Walker BF, Hebert JJ, Stomski NJ, et al. Outcomes of usual chiropractic. The OUCH randomized controlled trial of adverse events. Spine (Phila Pa 1976) 2013; 38:1723.
- Stevinson C, Ernst E. Risks associated with spinal manipulation. Am J Med 2002; 112:566.
- Carlesso LC, Gross AR, Santaguida PL, et al. Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: a systematic review. Man Ther 2010; 15:434.
- Shekelle PG, Adams AH, Chassin MR, et al. Spinal manipulation for low-back pain. Ann Intern Med 1992; 117:590.
- Hurwitz EL, Aker PD, Adams AH, et al. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine (Phila Pa 1976) 1996; 21:1746.
- Rothwell DM, Bondy SJ, Williams JI. Chiropractic manipulation and stroke: a population-based case-control study. Stroke 2001; 32:1054.
- Smith WS, Johnston SC, Skalabrin EJ, et al. Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology 2003; 60:1424.
- Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine (Phila Pa 1976) 2008; 33:S176.
- Hufnagel A, Hammers A, Schönle PW, et al. Stroke following chiropractic manipulation of the cervical spine. J Neurol 1999; 246:683.
- SPINAL MANIPULATION
- Types of manipulation
- Postulated mechanisms of benefit
- LOW BACK PAIN
- NECK PAIN AND HEADACHE
- Efficacy of manipulation for neck pain
- Efficacy of manipulation for headache
- OTHER CLINICAL CONDITIONS
- RISKS OF SPINAL MANIPULATION
- Minor complaints
- Serious adverse events
- SUMMARY AND RECOMMENDATIONS