Ian D. Coulter
Public Health Dentistry,
School of Dentistry,
UCLA, Los Angeles, CA, USA
Chiropractors account for around 90% of the manipulation in the United States, and more than 94% of chiropractic patients receive some form of manipulation. This article reports on two studies of the appropriateness of manipulation conducted at RAND using systematic literature reviews and expert panels.
Two areas were focused on: manipulation for low-back pain and manipulation and mobilization of the cervical spine. The systematic review of the literature (including a meta-analysis) for the evidence for manipulation for low-back pain indicated that spinal manipulation was more efficacious than the comparison treatments for patients with acute or sub-acute low-back pain uncomplicated by sciatica.
For cervical manipulation, the systematic literature review indicated efficacy for neck pain and for patients with muscle-tension-type headache. For both cervical manipulation and manipulation for low-back pain, the literature reports low levels of complications. For cervical manipulation, the estimated risk for serious complications is 6.39 per 10 million manipulations. For lumbar manipulation the estimate is 1 serious complication per 100 million manipulations. Although the evidence of the efficacy for manipulation is not overwhelming, there is sufficient evidence to establish efficacy for acute conditions and sufficient evidence to warrant serious investigation of its efficacy in other areas. The risk from manipulation is low and compares favorably to other forms of therapy for the same conditions (e.g., 15.6 complications per 1000 cervical spine surgeries, 3.2 per 1000 subjects for nonsteroidal anti-inflammatory drugs).