November 2004

British researchers find spinal manipulation
provides relief for back pain

Spinal manipulation, in the form of chiropractic, osteopathy or manipulative physiotherapy, followed by a program of exercise, provides significant relief of symptoms and improvements in general health, according to a trial by the Medical Research Council (MRC). The results of the trial were published November 19 in the online edition of British Medical Journal.

According the MRC, which is a national research organization funded by Parliament, lower back pain is one of the most common ailments general practitioners have to treat.

The MRC trial recruited more than 1,300 patients from across the UK, whose back pain had not improved after receiving "best care" in general practice, to assess the effectiveness of three different treatments. The treatments were:

• A class-based physical exercise program;
• Spinal manipulation;
• A combined package of spinal manipulation followed by a program of exercise.

The results showed that patients in all treatment groups reported improved back function and reduced pain over time, but to varying degrees. On average, patients assigned to exercise classes in addition to care by a general practitioner (GP) reported a small benefit at three months but not at one year.

Those assigned to spinal manipulation in addition to GP care reported a small to moderate benefit at three months and a small, on average, benefit at one year.

The greatest improvement was found in the patients assigned to combined manipulation and exercise in addition to GP care. They reported a moderate, on average, improvement at three months and a smaller average improvement at one year. These benefits were the same whether treatment was delivered using private or National Health Service (NHS) premises.

An economic analysis was also carried out. It showed that the cost to the NHS of all three treatments was modest. It also showed that both spinal manipulation and the combined package of spinal manipulation and exercise achieved similar benefits to patients at a similar cost to the NHS.

Martin Underwood, professor of general practice at Queen Mary, University of London, was one of the lead researchers in the trial team. He said:

"One of the commonest health problems I'm asked to treat as a GP is back pain. This trial has shown that physical treatments - a combined package of spinal manipulation and exercise in particular - may offer relief to the large numbers of patients whose back pain persists after they've received best care from their GP."

Ian Russell, professor of public health and director of the Institute of Medical and Social Care Research at the University of Wales Bangor, said, "Our analysis showed that the cost to the NHS was modest. Added to GP 'best care', spinal manipulation gives the best value for money."

According to the American Chiropractic Association, the MRC study is one of a number of recent studies regarding chiropractic's effectiveness for back pain over traditional medical care.

A March 2004 study in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients' first year of symptoms. And a study published in the July 15, 2003, edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than does a variety of medications.

Sources: Medical Research Council, http://www.mrc.ac.uk; American Chiropractic Association, http://www.amerchiro.org

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