Spinal Manipulation for Low Back Pain
Authors: John D. Childs
Journal: Annals of Internal Medicine (2004)

Letters20 April 2004Spinal Manipulation for Low Back PainJohn D. Childs, PT, PhD and Timothy W. Flynn, PT, PhDJohn D. Childs, PT, PhDFrom Wilford Hall Medical Center, Schertz, TX 78154; and Regis University, Denver, CO 80221. and Timothy W. Flynn, PT, PhDFrom Wilford Hall Medical Center, Schertz, TX 78154; and Regis University, Denver, CO 80221.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-8-200404200-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Assendelft and colleagues (1) concluded that spinal manipulation is not more effective than other active interventions for low back pain. Of interest, this conclusion contrasts with the authors' previous findings suggesting a benefit (2-4). Conclusions may vary across trials of spinal manipulation because researchers often fail to adequately consider the importance of classification. Using broad inclusion criteria results in a heterogeneous sample that may include many patients for whom no benefit is expected, thus masking the intervention's true value. In their meta-analysis, Assendelft and colleagues questioned the need for future clinical trials, an action that could perpetuate ...References1. Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med. 2003;138:871-81. [PMID: 12779297] LinkGoogle Scholar2. Assendelft WJ, Koes BW, van der Heijden GJ, Bouter LM. The efficacy of chiropractic manipulation for back pain: blinded review of relevant randomized clinical trials. J Manipulative Physiol Ther. 1992;15:487-94. [PMID: 1402408] MedlineGoogle Scholar3. Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH. Spinal manipulation for low-back pain. Ann Intern Med. 1992;117:590-8. [PMID: 1388006] LinkGoogle Scholar4. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21:2860-71. [PMID: 9112710] CrossrefMedlineGoogle Scholar5. Flynn T, Fritz J, Whitman J, Wainner R, Magel J, Rendeiro D, et al . A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002;27:2835-43. [PMID: 12486357] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: John D. Childs, PT, PhD; Timothy W. Flynn, PT, PhDAffiliations: From Wilford Hall Medical Center, Schertz, TX 78154; and Regis University, Denver, CO 80221. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSpinal Manipulative Therapy for Low Back Pain Willem J.J. Assendelft , Sally C. Morton , Emily I. Yu , Marika J. Suttorp , and Paul G. Shekelle Spinal Manipulation for Low Back Pain Carl M. Shapiro Spinal Manipulation for Low Back Pain Paul G. Shekelle , Sally C. Morton , and Willem J.J. Assendelft Metrics Cited bySpinal ManipulationComparison of ischemic compression and lumbopelvic manipulation as trigger point therapy for patellofemoral pain syndrome in young adults: A double-blind randomized clinical trialImmediate Effects of Lumbopelvic Manipulation and Lateral Gluteal Kinesio Taping on Unilateral Patellofemoral Pain SyndromeSpinal DisordersManual TherapyIs there a place for science in the definition of osteopathy?Clinical Prediction Rules: Time to Sacrifice the Holy CowPhysical Therapy and Manual Physical Therapy for Patients with Non-Specific Low-Back Pain: Differences in Patient Characteristics with Implications for Diagnostic Classification 20 April 2004Volume 140, Issue 8Page: 665KeywordsClinical trialsForecastingHealth careLikelihood ratioLower back pain ePublished: 20 April 2004 Issue Published: 20 April 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...