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Chiropractic treatment of low back pain

A review using randomized controlled trials

Chiropraktische Behandlung bei unteren Rückenschmerzen

Eine Übersichtsarbeit mittels randomisierter kontrollierter Studien

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A Übersichten to this article was published on 05 March 2021

Abstract

Background

Lower back pain is one of the most common public health problems worldwide, with far-reaching social, psychological, and financial consequences for those affected. It can result in impairment of quality of life and lasting damage. This article deals with the following question: Is chiropractic treatment of lower back pain a clinically relevant, effective treatment method compared to other therapies, and does it therefore represent a standard treatment?

Methods

The literature research was conducted in the PubMed database. The evidence level of the individual studies was determined based on the PEDro scale. After determining the evidence levels of the individual studies, the studies rated level I were evaluated using tables according to the PICO model in comparison to other treatment methods. Investigated endpoints were back pain and the resulting restriction of movement.

Results

Of 1046 researched articles, there were 169 on the topic, including 54 systematic reviews and 115 randomized clinical trials (RCTs); 13 RCTs were suitable for a direct treatment comparison for the review. In the direct comparison with McKenzie therapy, better results were achieved for McKenzie. Otherwise, there were slightly better results for the intervention groups.

Conclusion

Just like McKenzie therapy, the chiropractic treatments achieved best results in improvement of lower back pain and the resulting movement restrictions. The differences in results between the intervention and control groups were small. The studies investigated exhibited methodological weaknesses. The results show that chiropractic treatment of low back pain is not a clinically relevant, effective treatment and is therefore not a standard therapy based on the studies evaluated.

Zusammenfassung

Hintergrund

Untere Rückenschmerzen gehören weltweit zu den häufigsten Problemen der öffentlichen Gesundheit mit weitreichenden Folgen für die Betroffenen im sozialen, psychologischen und finanziellen Bereich. Einschränkungen der Lebensqualität sowie verbleibende Schädigungen können die Folge sein. Der vorliegende Beitrag beschäftigt sich mit der Frage: Ist Chiropraktik bei unteren Rückenschmerzen im Vergleich zu anderen Therapien eine klinisch relevante, nachhaltige Behandlungsmethode und stellt sie somit eine Standardtherapie dar?

Methode

Die Literaturrecherche erfolgte in der Datenbank PubMed. Der Evidenzlevel der einzelnen Studien wurde anhand der PEDro-Skala ermittelt. Danach wurden die mit Level I bewerteten Studien nach dem PICO-Modell tabellarisch im Vergleich zu anderen Therapieverfahren ausgewertet. Untersuchte Endpunkte waren Rückenschmerzen und daraus resultierende Bewegungseinschränkungen.

Ergebnisse

Von 1046 recherchierten Artikeln fanden sich 169 zum Thema, davon 54 systematische Übersichtsarbeiten und 115 randomisierte klinische Studien (RCT); 13 RCT waren für einen direkten Therapievergleich für die Übersicht geeignet. Im direkten Vergleich mit der McKenzie-Therapie wurden bessere Ergebnisse für McKenzie erreicht. Ferner gab es geringfügig bessere Ergebnisse für die Interventionsgruppen.

Schlussfolgerungen

Die chiropraktischen Behandlungen erreichten genau wie McKenzie-Therapie beste Resultate bei den Verbesserungen von unteren Rückenschmerzen und den daraus resultierenden Bewegungseinschränkungen. Die Ergebnisunterschiede zwischen den Interventions- und Kontrollgruppen waren gering. Die untersuchten Studien wiesen methodische Schwächen auf. Die Ergebnisse der Auswertung zeigen, dass Chiropraktik bei unteren Rückenschmerzen keine klinisch relevante, nachhaltige Behandlung und somit keine Standardtherapie darstellt.

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Notes

  1. Chiropractic treatment is also referred to in the studies as manipulation treatment, manipulative treatment, manipulative therapy, chiropractic spinal manipulation, spinal manipulation, and joint manipulation.

  2. For subjects who did not receive the treatment but for whom it was nevertheless possible to measure results, the measured values were analyzed as if the subject had received the treatment intended for him or her.

  3. As a rule, the RMDQ‑D can be used for back pain patients (acute/subacute/chronic). It evaluates a range of bodily functions and activities with 24 specific questions. Psychosocial function is not factored in. Clinically relevant results differ by at least 5 points.

  4. The McKenzie concept is a method of physiotherapy developed by New Zealand physiotherapist Robin McKenzie.

  5. The number needed to treat, NNT for short, is a term from medical statistics. It is used for comparing treatment methods. It is the number of treatments believed to be needed to achieve a single positive outcome compared to an alternative method.

Abbreviations

DC:

Group with chiropractic treatment

DCPm:

Group with chiropractic treatment including physical modalities

HVLA:

High-velocity, low-amplitude

LBP:

Lower back pain

MD:

Group with medical treatment

MDPt:

Group with medical treatment including physical therapy

NNT:

Number needed to treat

NRS:

Numerical rating scale

PEDro:

Physiotherapy Evidence Database

RCT:

Randomized controlled trial

RMDQ:

Roland–Morris Disability Questionnaire

VAS:

Visual analog scale

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  1. Weinstr. 4, 80333, Munich, Germany

    Rainer Thiele M.A.

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Correspondence to Rainer Thiele M.A..

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R. Thiele declares that he has no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Thiele, R. Chiropractic treatment of low back pain. Manuelle Medizin 59 (Suppl 1), 1–8 (2021). https://doi.org/10.1007/s00337-021-00770-1

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