SPINAL MANIPULATION FOR LOW BACK PAIN: CHARLATAN CHICANERY OR SCIENTIFICALLY-TESTED TREATMENT?
Spinal Manipulation for Low Back Pain:
Charlatan, Chicanery or Scientifically-tested Treatment?
Most orthopedic surgeons have been suspicious,
even disbelieving, of the beneficial effects of spinal manipulation for back
pain. Some consider this type of chiropractic to border on charlatanry.
Recommendations contained in the Agency for Health Care Policy and Research's
Clinical Practice Guideline for Acute Low Back Problems in Adults have renewed
interest in the spinal manipulation debate. Recent reports in the medical
literature have heralded the benefits of manipulation compared to physical
therapy, and increasing numbers of insurers and HMOs are covering visits to
chiropractors. All seem to indicate that spinal manipulation is gaining in
scientific and practical acceptance. However, some spine surgeons are concerned
about the lack of a true definition for spinal manipulation beyond "the
laying on of hands to move the spine for the benefit of the patient," and
that the literature supporting the procedure's efficacy describes various
techniques used in different situations with outcomes measured at differing
lengths of time.
In our Counterpoints this month, two
former presidents of the North American Spine Society present their opposing
viewpoints on spinal manipulation. It is obviously very difficult to make such a
comparison, even in a prospective study, when the results are so subjective and
influenced by so many subjective and emotional variables. Perhaps the reader can
draw his own conclusion from these opinions.
Spinal Manipulation: How Did It Get So Accepted?
by Scott Haldeman, MD, PhD
Acute Back Pain Treatment Rationale Should Be Clear
by Vert Mooney, MD
Copyright 1996, SLACK Incorporated. Revised 13 March 1996.