Study 4: “Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomized controlled trials” Rubinstein et al.

This systematic review included 47 randomized controlled trials with 9,211 participants total comparing spinal manipulative therapy for chronic low back pain to other interventions. This study found that spinal manipulative therapy achieves similar short term pain relief and better functional improvement compared to guideline recommended therapies. Compared to guideline non-concordant therapies spinal manipulative therapy achieves a small improvement in pain and small to moderate improvement in function. Additionally, most of the adverse events found for spinal manipulative therapy were transient muscle soreness with only one study reporting a serious adverse event that may have been related to spinal manipulative therapy. The key takeaway is that spinal manipulative therapy may achieve similar or better results to most interventions for chronic low back pain with low risk of adverse events. It is often missed and misunderstood that when a therapeutic intervention is compared; achieving a “similar or better result” is a significant finding.  Those terms are often overlooked and the impact is minimized.  Researchers understand the impact of those findings. Full study available at:

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