A systematic review of systematic reviews of spinal manipulation

A systematic review of systematic reviews of spinal manipulation
2006 April
E Ernst and P H Canter
Journal of The Royal Society of Medicine
PubMed Central

Copyright © 2006, The Royal Society of Medicine

Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK
Correspondence to: Professor E Ernst
E-mail: Edzard.Ernst@pms.ac.uk
This article has been cited by other articles in PMC.

AbstractObjectives: To systematically collate and evaluate the evidence from recent systematic reviews of clinical trials of spinal manipulation.
Design: Literature searches were carried out in four electronic databases for all systematic reviews of the effectiveness of spinal manipulation in any indication, published between 2000 and May 2005. Reviews were defined as systematic if they included an explicit and repeatable inclusion and exclusion criteria for studies.

Results: Sixteen papers were included relating to the following conditions: back pain (n=3), neck pain (n=2), lower back pain and neck pain (n=1), headache (n=3), non-spinal pain (n=1), primary and secondary dysmenorrhoea (n=1), infantile colic (n=1), asthma (n=1), allergy (n=1), cervicogenic dizziness (n=1), and any medical problem (n=1). The conclusions of these reviews were largely negative, except for back pain where spinal manipulation was considered superior to sham manipulation but not better than conventional treatments.

Conclusions: Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.

INTRODUCTIONSpinal manipulation (SM) is a traditional form of treatment practised by chiropractors, osteopaths, physiotherapists and other healthcare providers mostly (but not exclusively) to treat musculoskeletal problems. A precise definition of SM is still under debate1 but most experts would probably agree that SM can be described as `the use of hands applied to the patient incorporating the use of instructions and manoeuvres to achieve maximal painless movement and exposure of the musculoskeletal system'2 or as `the application of a load (force) to specific body tissues with therapeutic intent'.3 The postulated modes of action of SM include: increase of joint movement, changes in joint kinematics, increase of pain threshold, increase of muscle strength, attenuation of alpha-motoneuron activity, enhanced proprioceptive behaviour, as well as release of beta-endorphins and substance P3.

Spinal manipulation is popular. About 70 000 chiropractors are licensed in the US, 10 000 in Japan, 6000 in Canada, 2500 in Australia and 16 000 in the UK.4 The costs associated with SM are substantial.5 It is therefore desirable to define the effectiveness of this approach as closely as possible. Numerous systematic reviews of SM are available but they frequently arrive at vastly different conclusions. This article summarizes the evidence from recent systematic reviews and aims at clearing some of the existing confusion about the effectiveness of SM.

Complete article may be viewed online.