Modest Effect of Spinal Manipulation For Back Pain Interview with:

Paul Shekelle, MD PhD MPH Chief of General internal Medicine VA Greater Los Angeles Healthcare System

Dr. Shekelle

Paul Shekelle, MD PhD MPH
Chief of General internal Medicine
VA Greater Los Angeles Healthcare System What is the background for this study? What are the main findings?

Response: Back pain is one of the commonest symptoms for adult patients to seek health care. For a number of years now, VA has had chiropractic care integrated into the ambulatory care available at many large VA medical centers. Most patients referred from VA primary care to chiropractic clinic have chronic back pain. VA was interested in an evidence synthesis of the use of spinal manipulative therapy in acute low back pain. Spinal manipulative therapy is a manual technique delivered by almost all chiropractors, but also delivered by some physical therapists, osteopathic physicians, and some medical doctors.

The main findings are that spinal manipulative therapy is associated with, on average, a modest beneficial effect on pain and function. However, there are large difference sin outcome across studies, and this suggests that some patients may respond much better, and other may respond not at all. What should readers take away from your report?

Response: Spinal manipulative therapy is one treatment option for patients with acute low back pain. Like other treatment options for acute low back pain such as NSAIDs or muscle relaxant medications, it is not a cure by any means. The average effects are modest. Most acute low back pain gets better without any specific treatment What recommendations do you have for future research as a result of this study?

Response: I think the finding of large between-study differences, plus the results of studies of a clinical prediction rule, suggest that there may be persons who respond better to spinal manipulative therapy and it may be possible to prospectively identify them. This would be a good area for future research.

Because of my expertise in spinal manipulative therapy research I am a co-author of the chapter on SMT for the online medical textbook UpToDate.

Thank you to the VA Greater Los Angeles Healthcare System Thank you for your contribution to the community.


Paige NM, Miake-Lye IM, Booth MS, Beroes JM, Mardian AS, Dougherty P, Branson R, Tang B, Morton SC, Shekelle PG. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back PainSystematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460. doi:10.1001/jama.2017.3086

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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