Wow, 2018 starts with a meta-analysis of chronic low back pain in the Spine Journal: https://www.sciencedirect.com/science/article/pii/S1529943018300160
Article is funded by the National Institute of Health and reviews fifty one studies from 2000 to 2017 comparing Manipulation and Mobilization to Exercise and Physical Therapy.
Manipulation significantly reduced pain and disability compared with exercise and physical therapy. The Conclusion: There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain.
If “moderate-quality evidence” doesn’t sound strong enough, look no further than the March Issue of the Lancet with three separate articles regarding low back pain. You’ll have to register for access to the full article: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30489-6.pdf
The authors are pretty brutal regarding a number of interventions: Non-evidence-based practice is apparent across all income settings; common problems are presentations to emergency departments and liberal use of imaging, opioids, spinal injections, and surgery.
There is a great table within the second article listing intervention treatment options and those that are not recommended before six weeks and after twelve weeks. Education, advice to remain active, NSAIDs, exercise, spinal manipulation massage and acupuncture receive recommendations. Epidural steroidal injection comes under specific criticism noting “limited use in selected patients” after 12 weeks. Spinal fusion has insufficient evidence under six weeks and it’s role is uncertain after twelve weeks. Discectomy and laminectomy remain options following 12 weeks.
