Low back pain is one of the more common banes of the blue collar workers’ existence. Workers whose jobs require them to bend, lift, squat, twist, or contort themselves into unusual positions are incredibly susceptible to straining their low back. Missed time from work is an economic and disadvantageous consequence of low back pain so it behooves medical providers to have an effective treatment regimen they can rely on to get folks back to work.
One such treatment is spinal manipulation. Practiced most often by chiropractors, it can also be found in the treatment milieu of osteopaths and physical therapists. Pain relief is obtained by manipulating the spine with a series of quick thrusts of the joints of the spine and pelvis. The treated joints are subjected to varying degrees of pressure and movement that cause a popping sound and a relaxed feeling. Manipulation is done until pain is improved, and the patient’s movements are restored to a more normal state.
If the patient chooses the chiropractic therapy option, they will almost certainly undergo spinal manipulation. We’ve all seen videos of chiropractors treating patients lying on a table, torso twisted, receiving a sudden jerk to their back and pelvis. They feel better, but does this technique really help? How does it compare to other treatments of low back pain that involve drugs, applications of heat or ice, and other procedures? Well, a study out of Minnesota attempts to answer the question.
One thousand low back pain patients, deemed to be at risk for chronic disabling low back pain, were divided into 4 treatment groups. They were observed and treated from 2018 to 2023. The four treatment groups were:
1. Spinal Manipulation alone
2. Spinal Manipulation plus supported self-management (one-on-one session focusing on
physical, psychological, and social strategies).
3. Self-management alone
4. Guideline-based medical care—NSAID’s, Muscle Relaxants, ice/heat, etc.
The results of treatment were based on a low back disability score. Scores ranged from “0” to “24”, with “0” being the best result and “24” the worst. At the beginning of the treatment period the average score was 11.4, or near the middle of the range. The goal of treatment was to improve the baseline score (lessen the number) by 50% (half).
Here are the results:
Spinal manipulation (SM) alone improved the score to 5.5
SM plus supported self-management improved the score to 4.8
Supported self-management alone improved the score to 4.7
Guideline-based medical care improved the score to 5.9
CONCLUSION: All treatment options achieved the goal of improving the disability score 50% or more. The largest improvement was with supported self-management alone. Spinal manipulation did not add to that nor did it exceed the others including what most doctors do—guideline-based medical care.
So, it appears spinal manipulation is no more effective than regular low back care. Spinal manipulation alone is only helpful if supported self-management is added. That combination seemed to work best. It pains me to admit this, but these results lend credence to the “adjustments” chiropractors do and actually somewhat validate their existence. I think the “hands-on” approach of chiropractic helps to strengthen to bond between chiropractor and patient, thus improving results.
Dr. G’s Opinion: My approach to LBP was most often rest, exercise, heat/ice, NSAID’s, and PT. This combination worked well 96% of the time. My purpose is not to demean chiropractors, but spinal manipulation alone provides little benefit over all other treatments.
Reference: Brauser D. “Which Nonpharmacologic Therapy is Best for Low Back Pain?” Medscape 2026 January 8.
Excellent summation. I agree.
Thanks