A study to be published in next month’s issue of the Journal of the Royal Society of Medicine has raised serious questions about the efficacy of spinal manipulation treatment.
Spinal manipulation is commonly practiced by chiropractors and osteopaths. It is a popular form of manual treatment for back and neck pain with an estimated 16,000 licensed chiropractors in the UK.
“There is little evidence that spinal manipulation is effective in the treatment of any medical condition,” said Professor Edzard Ernst of the Peninsula Medical School at Exeter.
“The findings are of concern because chiropractors and osteopaths are regulated by statute in the UK.
“Patients and the public at large perceive regulation as proof of the usefulness of treatment. Yet the findings presented here show a gap and contradiction between the effectiveness of intervention and the evidence.”
Professor Ernst’s paper examined all systematic reviews published on spinal manipulation between 2000 and May 2005. Sixteen papers were included in the research relating to the following condition: back pain, neck pain, primary and secondary dysmenorrhoea, infantile colic, asthma, allergy and cervicogenic dizziness.
“Collectively these data did not demonstrate that spinal manipulation is an effective intervention for any of these conditions, except for back pain where it is superior to sham manipulation but not better than conventional treatments,” write the authors.
“Considering the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.”
The study also highlights the risk of spinal manipulation treatment.
“Spinal manipulation [SM] has been associated with frequent, mild adverse effects and with serious, probably rare implications,” write the authors.
“Therefore the risk-benefit balance does not favour SM over other treatment options such as therapeutic exercise. This statement is not in agreement with several national guidelines…but we suggest that these guidelines be reconsidered in the light of the best available data,” they conclude.
Professor Ernst said the findings confirm fears that in ‘alternative’ medicine regulation often serves as a substitute for research.
“Previous studies have shown that regulation of chiropractors was followed by a decrease in research activity,” said Professor Ernst.
“The evidence presented here should be seen as a wake-up call to the chiropractic profession.
“One way forward is more rigorous clinical trials to test the efficacy of spinal manipulation, after all, the treatment is not without risk and chiropractors must demonstrate why it should be a recommendable medical treatment option,” Professor Ernst said.
- A systematic review of systematic reviews of spinal manipulation [PDF 70k]
Les chiropracteurs demeurent pourtant les "champions de la manipulation" ... médiatique s'entend.
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