Results of the RELIEF Study of spinal manipulation and mobilization techniques left something to be desired. The study was published in the Journal of the American Medical Association Network Open in early August under the title, “Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain.”
Chiropractic Foundation: Leave Spinal Manipulation to Us
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The study authors concluded that neither spinal manipulation therapy nor spinal mobilization provided more relief for chronic low back pain than a sham cold laser therapy placebo.
What initially sounds like an open and shut case against the use of spinal manipulation and mobilization to treat pain has become a selling point for the Foundation for Chiropractic Progress (F4CP). The not-for-profit group that represents doctor of chiropractic (D.C.).
The group locked onto an important detail of the study—all of the practitioners who participated were either doctors of osteopathy, or physical therapists. Citing previous literature showing the successes of similar manipulation and mobilization techniques by doctor of chiropractic the group points out that the latest study is further proof that the techniques should be left to the experts.
Recently promoted F4CP President Sherry McAllister, D.C., stated, “Many consumers and even some medical professionals still assume that spinal manipulation is equally effective regardless of the provider type.”
“These findings, when taken along with the findings of previous papers, help to differentiate the effectiveness of spinal manipulation for low back pain delivered in the context of chiropractic care. This helps explain why historically 94% of spinal manipulation is provided by doctors of chiropractic. This study also brings into question the effectiveness of mobilization of the spine for low back pain as provided by physical therapists and osteopaths.”
One of the additional publications sited by the organization in its statement is a randomized clinical trial that was published in Spine (Phila Pa 1976) in 2013. That study found chiropractic manipulation to significantly improve outcomes for pain and physical function when combined with standard medical care for the treatment of low back pain.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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