Evidence for the benefit of Chiropractic in the Treatment of Low Back Pain
N.I.C.E. Guidelines, UK
Manual therapies
1.2.7 Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy.
https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#assessment-of-low-back-pain-and-sciatica
Meade et al (1995) Randomised comparison of
chiropractic and hospital outpatient treatment for
low back pain: results from extended follow up. BMJ
311; 349-351
Funded by the MRC, confirmed the findings of the earlier report.
RCGP (1999) Clinical Guidelines for the Management
of Acute Low Back Pain
Funded by the Royal College of General Practitioners proved
that the risks of manipulation are very low in skilled hands and
it can provide short-term improvement in pain and activity
levels and higher patient satisfaction.
UK BEAM Trial Team (2004) United Kingdom back
pain exercise and manipulation (UK BEAM)
randomised trial: effectiveness of physical
treatments for back pain in primary care. BMJ
329:1377
Funded by the MRC, showed that exercise was better than “best
care” in general practice at three months. Adding manipulation
there was further improvement at three months and at 12
months.
UK BEAM Trial Team (2004) United Kingdom back
pain exercise and manipulation (UK BEAM)
randomised trial: cost effectiveness of physical
treatments for back pain in primary care. BMJ
329:1381
Spinal manipulation is a cost effective addition to “best care”
for back pain in general practice. Manipulation alone probably
gives better value for money than manipulation followed by
exercise.
NICE (2006) IPG 183 – Non-rigid stabilisation
techniques for the treatment of low back pain –
guidance
Results showed that chiropractic intervention and posture
training can limit episodes of acute pain. Spinal rehabilitation
can also be beneficial.
Department of Health (2006) Musculoskeletal
Services Framework
Showed that chiropractors provide evidence-based, timely and
effective assessment, diagnosis and management of certain
musculoskeletal disorders.
Low back pain: early management of persistent non-
specific low back pain
NICE guidelines May 2009
The evidence-based recommendations include the following:
Provide people with advice and information to promote self-
management of their low back pain.
Consider offering a course of manual therapy including spinal
manipulation of up to 9 sessions over up to 12 weeks
Consider offering a course of acupuncture needling comprising
up to 10 sessions over a period of up to 12 weeks
Consider offering a structured exercise programme tailored to
the individual.
European Commission Research Directorate General
(2004) European Guidelines for the management of
chronic non-specific low back pain in primary care
(2004)
Recommendation: Consider a short course of spinal
manipulation/mobilisation as a treatment option for chronic
low back pain.
European Commission Research Directorate General
(2004) European Guidelines for the management of
acute non-specific low back pain in primary care
Findings were not to prescribe bed rest but advise patients to
continue normal activities and take pain relief and muscle
relaxants, as required. Also to consider referral for spinal
manipulation.
CSF
CSF: Cerebrospinal Fluid production and reabsorption
Produced in the choroid plexus of the lateral ventricles of the cerebrum, this fluid surrounds and nourishes the gray and white matter of the brain, as well as that of the spinal cord.
Reabsorption occurs via the subarachnoid lymphatic system (and potentially not the arachnoid villi as previously thought); primarily in the area of the cribiform plate (at the floor of the cranium, just above the nose). This has been shown recently by Johnston, Toronto Canada.
The CSF and therefore the intra-cerebral vaults, can be accessed via the cauda equina levels of the lumbar spine (lumbar puncture). Complications such as Hydrocephalus, can occur when the reabsorption or flow of CSF between the brain and the spinal cord is compromised.