More than 50 mostly qualitative, nonsystematic reviews that address the role of spinal manipulation and mobilization in the treatment of patients with low back or neck pain have been published since 1979. Many of these reports were of inadequate methodologic quality. 

Bronfort et al used a best-evidence data synthesis method to review the literature for clinical trials involving patients with low back or neck pain. These trials included 10 or more subjects per group; the subjects received spinal manipulation (“spinal manipulative treatment”), mobilization, or a combination of both forms of therapy. A literature search for relevant randomized clinical trials published through 2002 was performed using several electronic databases. Sixty-nine randomized clinical trials of low back or neck pain met the selection criteria. 

Investigators identified 46 low back pain trials of spinal manipulation and/or mobilization. Thirty-one of these trials met the inclusion criteria (N=5202). 

For patients with acute low back pain, researchers found moderate evidence that spinal manipulation provides more short-term pain relief than either mobilization or detuned short-wave diathermy. For patients with chronic low back pain, there is moderate evidence that spinal manipulation has an effect similar to that of efficacious prescription nonsteroidal anti-inflammatory drugs. 

Bronfort et al found limited to moderate evidence that spinal manipulation is more efficacious than physical therapy and home back exercises in both the short and long term. The authors also reported that spinal manipulation and/or mobilization are effective in the short-term relief of low back pain when compared with either placebo or traditional care from general practitioners. 

The investigators identified 23 neck pain trials of spinal manipulation and/or mobilization. Only 12 of these trials met the inclusion criteria (N=1172). 

The evidence was inconclusive regarding the efficacy of spinal manipulation or mobilization in the short-term management of acute neck pain. There was no evidence available regarding spinal manipulation or mobilization in the long-term management of acute neck pain. 

There was moderate evidence that spinal manipulation and mobilization are superior to both management by general practice medical care and physical therapy in the short term for improving physical functioning of patients with chronic neck pain. Spinal manipulation was found to have at best a similar efficacy to high-technology rehabilitative exercise in the short term and long term for treating patients with chronic neck pain. 

Spinal manipulation and/or mobilization may be a viable option for the treatment of patients with low back pain. However, there have been few high-quality trials distinguishing between patients with acute and chronic symptoms of low back pain. 

 

Regarding the efficacy of spinal manipulation or mobilization in the treatment of patients with acute neck pain, the evidence is inconclusive. For chronic neck pain, the investigators found moderate evidence that both spinal manipulation and mobilization are superior to management by general practice physicians for short-term pain reduction. However, spinal manipulation offers at best similar pain relief to high-technology rehabilitative exercise in the short term and long term. The overall evidence is not clear for the efficacy of spinal manipulation or mobilization when studied in groups of patients with a mixture of acute and chronic neck pain.