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Chiropractic Research Review

LBP: Which Techniques Work Best?

The extensive variety of chiropractic techniques used to treat low back pain (LBP) necessitate guidelines based on the effectiveness of different chiropractic procedures. LBP is the primary condition treated by chiropractors, but solid evidence comparing the effectiveness of specific adjustments is lacking.

The RAND study and the Agency for Health Care Policy and Research (AHCPR) guidelines do not fully differentiate between various low back conditions or the efficacy of specific techniques used to treat these conditions.

This study rated specific chiropractic techniques for different LBP conditions, using clinical expertise and published clinical evidence. Both acute and chronic conditions were considered. A panel of eight chiropractors was selected for their knowledge, involvement, and academic experience related to chiropractic techniques. The panel members rated 10 procedures (from 0 to 10) for eight low back conditions, using literature from 1976-1996. The primary findings of the study were:

* The three most effective procedures overall were high-velocity, low-amplitude (HVLA) adjustments with no drop table (side posture); distraction technique; and prone HVLA with drop table assist.

* The least effective techniques for low back conditions were upper cervical technique; non-thrust reflex/low force technique; and lower-extremity adjusting.

* The most responsive conditions to chiropractic were noncomplicated LBP; sacroiliac joint dysfunction; posterior joint subluxation; and LBP combined with buttock pain.

* The least responsive conditions were LBP with leg pain; buttock/leg pain (only); and herniated disc.

The authors note that evaluation of the effectiveness of different chiropractic techniques for various back problems is overdue, and that this study should merely be the beginning of necessary research. This information is vital for doctors of chiropractic to extend the maximum benefits to each patient.

Gatterman MI, Cooperstein R, Lantz C, et al. Rating specific chiropractic technique procedures for common low back conditions. Journal of Manipulative and Physiological Therapeutics 2001:24(7), pp. 449-456.

Chiropractic Research Review

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