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PTs and DOs Are Lousy at Spinal Manipulation | Forum

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Dynamic Chiropractic – August 1, 2020, Vol. 38, Issue 08

By Editorial Staff


While research supports the value of spinal manipulation for chronic low back pain when performed by doctors of chiropractic, a new study published in JAMA Network Open suggests doctors of osteopathy and physical therapists don't enjoy the same success.

According to the randomized clinical trial involving 162 young adults (average age: 25 years) with chronic, mild to moderate LBP, both spinal manipulation and mobilization were no more effective than placebo in reducing low back pain and related disability. "Licensed clinicians (either a doctor of osteopathic medicine or physical therapist), with at least 3 years of clinical experience using manipulative therapies provided all treatments."

Participants were randomized into one of three groups and received six treatment sessions of spinal manipulation, spinal mobilization or placebo (sham cold laser) over the course of three weeks (two sessions per week for three weeks). Primary outcome measures assessed included 1) change in Numerical Pain Rating Scale (NPRS) score over the past seven days; and 2) change in Roland-Morris Disability Questionnaire score 48-72 hours after completion of the six treatments.

unhappy face - Copyright – Stock Photo / Register Mark In their conclusion, the authors state: "Our findings indicated that spinal manipulation and spinal mobilization were no more effective than a well-chosen placebo in reducing pain and disability in patients with chronic low back pain. We conclude that these manipulative therapy techniques do not appear to be effective for chronic low back pain, at least among relatively young individuals with mild to moderate back pain."

Interesting ... but what if the treating clinicians had been doctors of chiropractic?  Here are just a few of the studies supporting chiropractic spinal manipulation for chronic LBP:

  • Giles LG, et al. Spine, 2003 Jul 15;28(14):1490-502.
  • Senna MK, et al. Spine, 2011 Aug 15;36(18):1427-1437.
  • Muller R, et al. JMPT, 2005;28(1)3-11.
https://www.dynamicchiropractic.com/mpacms/dc/article_d.php?id=58746&nr=t

JAMA study report:https://jamanetwork.com/journals/jamanetworkopen/fullarticle /2769031

If you flex lumbars and twist torso, then thrust, it is like when someone standing bends, twists and lifts a heavy object. Classic way to blow out a disc! Definitely not Chiropractic! 

excerpt:"Spinal Manipulation Treatment

The participant was placed in a side-lying position facing the clinician with the more painful side facing upward. The clinician passively flexed the participant’s hips and knees to induce lumbar spine flexion until they felt the spinous process of the affected lumbar vertebrae begin to move. Next, the clinician passively rotated the participant’s torso opposite to the side they were lying on until they felt rotation in the vertebra above the suspected lesion. The clinician applied a rapid thrust to the shoulder (anterior to posterior force) and pelvis (posterior to anterior force) resulting in a rotation force couple on the hypomobile segment. If a cavitation (ie, an audible pop) occurred, the treatment was considered complete. If no cavitation was produced, the participant was repositioned and the manipulation was attempted again. A maximum of 2 attempts per side was permitted. If no cavitation was produced after the 4 attempts (ie, 2 per side), the treatment was considered complete."


Almost like the study was designed to fail? Chiropractic does not profess to cure chronic low back pain in 6 visits over 2 weeks. It works by restoring function, thus removing the cause of pain. As opposed to "painkillers" that exacerbate the injury by covering up the symptoms, while creating addiction, high costs and, often, overdose. 
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