What the Science Says About Spinal Manipulation for Low-Back Pain

Overall, studies have shown that spinal manipulation is one of several options—including exercise, massage, and physical therapy—that can provide mild-to-moderate relief from low-back pain. Spinal manipulation also appears to work as well as conventional treatments such as applying heat, using a firm mattress, and taking pain-relieving medications.

In 2007 guidelines, the American College of Physicians and the American Pain Society included spinal manipulation as one of several treatment options for practitioners to consider when low-back pain does not improve with self-care. More recently, a 2010 Agency for Healthcare Research and Quality (AHRQ) report noted that complementary health therapies, including spinal manipulation, offer additional options to conventional treatments, which often have limited benefit in managing back and neck pain. The AHRQ analysis also found that spinal manipulation was more effective than placebo and as effective as medication in reducing low-back pain intensity. However, the researchers noted inconsistent results when they compared spinal manipulation with massage or physical therapy to reduce low-back pain intensity or disability.

Researchers continue to study spinal manipulation for low-back pain.

• A 2011 review of 26 clinical trials looked at the effectiveness of different treatments, including spinal manipulation, for chronic low-back pain. The authors concluded that spinal manipulation is as effective as other interventions for reducing pain and improving function.
• A 2010 review that looked at various manual therapies, such as spinal manipulation and massage, for a range of conditions found strong evidence that spinal manipulation is effective for chronic low-back pain and moderate evidence of its effectiveness for acute low-back pain.
• A 2009 analysis looked at the evidence from 76 trials that studied the effects of several conventional and complementary health practices for low-back pain. The researchers found that the pain-relieving effects of many treatments, including spinal manipulation, were small and were similar in people with acute or chronic pain.
• A 2008 review that focused on spinal manipulation for chronic low-back pain found strong evidence that spinal manipulation works as well as a combination of medical care and exercise instruction, moderate evidence that spinal manipulation combined with strengthening exercises works as well as prescription nonsteroidal anti-inflammatory drugs combined with exercises, and limited-to-moderate evidence that spinal manipulation works better than physical therapy and home exercise.

Researchers are investigating whether the effects of spinal manipulation depend on the length and frequency of treatment. In one study funded by NCCIH that examined long-term effects in more than 600 people with low-back pain, results suggested that chiropractic care involving spinal manipulation was at least as effective as conventional medical care for up to 18 months. However, less than 20 percent of participants in this study were pain free at 18 months, regardless of the type of treatment used.

Researchers are also exploring how spinal manipulation affects the body. In an NCCIH-funded study of a small group of people with low-back pain, spinal manipulation affected pain perception in specific ways that other therapies (stationary bicycle and low-back extension exercises) did not.

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