Spinal Manipulation for Low-Back Pain

Introduction

Low-back pain (often referred to as “lower back pain”) is a common condition that usually improves with self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications). However, it is occasionally difficult to treat. Some health care professionals are trained to use a technique called spinal manipulation to relieve low-back pain and improve physical function (the ability to walk and move). This fact sheet provides basic information about low-back pain, summarizes research on spinal manipulation for low-back pain, and suggests sources for additional information.

Key Points

• Spinal manipulation is one of several options—including exercise, massage, and physical therapy—that can provide mild-to-moderate relief from low-back pain. Spinal manipulation appears to work as well as conventional treatments such as applying heat, using a firm mattress, and taking pain-relieving medications.
• Spinal manipulation appears to be a generally safe treatment for low-back pain when performed by a trained and licensed practitioner. The most common side effects (e.g., discomfort in the treated area) are minor and go away within 1 to 2 days. Serious complications are very rare.
• Cauda equina syndrome (CES), a significant narrowing of the lower part of the spinal canal in which nerves become pinched and may cause pain, weakness, loss of feeling in one or both legs, and bowel or bladder problems, may be an extremely rare complication of spinal manipulation. However, it is unclear if there is actually an association between spinal manipulation and CES.
• Tell all your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About Low-Back Pain

Back pain is one of the most common health complaints, affecting 8 out of 10 people at some point during their lives. The lower back is the area most often affected. For many people, back pain goes away on its own after a few days or weeks. But for others, the pain becomes chronic and lasts for months or years. Low-back pain can be debilitating, and it is a challenging condition to diagnose, treat, and study. The total annual costs of low-back pain in the United States—including lost wages and reduced productivity—are more than $100 billion.

About Spinal Manipulation

Spinal manipulation—sometimes called “spinal manipulative therapy”—is practiced by health care professionals such as chiropractors, osteopathic physicians, naturopathic physicians, physical therapists, and some medical doctors. Practitioners perform spinal manipulation by using their hands or a device to apply a controlled force to a joint of the spine. The amount of force applied depends on the form of manipulation used. The goal of the treatment is to relieve pain and improve physical functioning.

Side Effects and Risks

Reviews have concluded that spinal manipulation for low-back pain is relatively safe when performed by a trained and licensed practitioner. The most common side effects are generally minor and include feeling tired or temporary soreness.

Reports indicate that cauda equina syndrome (CES), a significant narrowing of the lower part of the spinal canal in which nerves become pinched and may cause pain, weakness, loss of feeling in one or both legs, and bowel or bladder problems, may be an extremely rare complication of spinal manipulation. However, it is unclear if there is actually an association between spinal manipulation and CES, since CES usually occurs without spinal manipulation. In people whose pain is caused by a herniated disc, manipulation of the low back appears to have a very low chance of worsening the herniation.

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