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Back Pain

Faculty Viewpoints

In the January 1, 1993 Dynamic Chiropractic, Dr. Terry Elder wrote a very enlightening column titled, "We're Not Alone." Just in case you missed his point, I also would like to restate this fact: We really are not alone!

Each month I get telephone calls, fax messages, and letters from doctors of chiropractic asking for studies to validate manipulation as a treatment for back pain. My first response is: Did you order the Utah and Ebrall studies? If not, see the January 1, 1993 Dynamic Chiropractic, p. 3, and do it now. Then read Donald Petersen's column also on p. 3. Legislation and research are the hot topics of our profession, and will continue to be in 1993.

Legislation is currently being dealt with to some extent by the Mercy Guidelines. (If you have not read this yet, do it as soon as possible as your opinions are needed.) Research, on the other hand, is abundant and worldwide. It is not the fault of legislators or governments that you have not read the many studies that show the efficacy of spinal manipulation.

Recently, a colleague of mine compiled a list of controlled trials of manipulation for low back and neck pain. There are 25 papers for the low back and five for the cervical spine. All of these papers can be ordered from various sources including CRAC, care of the Canadian Memorial College of Chiropractic Library, Toronto, Canada, 1 (416) 482-2340. Included also are the Utah and Ebrall studies.

Hopefully you will take the time to get these studies, read them, and tell your patients, peers, and others that we are not alone; we are at the leading edge.

Controlled Trials of Manipulation for Low Back Pain

  1. Coyer AB, Curwen IHM: Low back pain treated by manipulation. Br Med Journal, 1:705-707, 1955.

     

  2. Edwards BC: Low back pain resulting from lumbar spine conditions: a comparison of treatment results. Aust J Physiotherapy, 15:104-110, 1969.

     

  3. Glover JL, Morris JG, Khosla T: Back pain: a randomized clinical trial of rotational manipulation of the trunk. Br J Ind Medicine, 31:59-64, 1974.

     

  4. Doran DML, Newell DJ: Manipulation in the treatment of low back pain: a multicentre study. Br Med Journal, 2:161-164, 1975.

     

  5. Bergquist-Ullman M, Larsson U: Acute low back pain in industry. Acta Orthop Scand (Suppl), 170:1-110, 1977.

     

  6. Evans DP, Burke MS, Lloyd KN, Roberts EE, Roberts GM: Lumbar spinal manipulation on trial: Part 1 -- Clinical Assessment. Rheumatology and Rehabilitation, 17:46-53, 1978.

     

  7. Sims-Williams H, Jayson MIV, Young SMS, Baddeley H, Collins E: Controlled trial of mobilization and manipulation for patients with low back pain in general practice. Br Med Journal, 1:1338-1340, 1978.

     

  8. Rasmussen GG: Manipulation in treatment of low back pain (a randomized clinical trial). Manuelle Medizin, 1:8-10, 1979.

     

  9. Sims-Williams H. Jayson MIV, Young SMS, Baddeley H, Collins E: Controlled trial of mobilization and manipulation for low back pain: hospital patients. Br Med Journal, 2:1318-1320, 1979.

     

  10. Hoehler FK, Tobis JS, Buerger AA: Spinal manipulation for low back pain. JAMA, 2245:1835-1838, 1981.

     

  11. Coxhead CE, Inskip H, Meade TW, North WRS, Troup JDG: Multicentre trial of physiotherapy in the management of sciatic symptoms. Lancet, 1:1065-1068, May 16, 1981.

     

  12. Zylbergold RS, Piper MC: Lumbar disc disease: Comparative analysis of physical therapy treatment. Arch Phys Med Rehabilitation, 62:176-179, 1981.

     

  13. Nwuga VBC: Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. Am J Phys Medicine, 61:273-278, 1982.

     

  14. Farrell JP, Twomey LT: Acute low back pain: comparison of two conservative treatment approaches. Med J Aust, 1:160-164, 1982.

     

  15. Godfrey CM, Morgan PP, Schatzker J: A randomized trial of manipulation for low back pain in a medical setting. Spine, 9:301-304, 1984.

     

  16. Gibson T, Grahame R. Harkness J, Woo P, Blagrave P, Hills R: Controlled comparison of short wave diathermy treatment with osteopathic treatment in nonspecific low back pain. Lancet, 1:1258-1261, 1985.

     

  17. Waterworth RF, Hunter IA: An open study of diflunisal conservative and manipulative therapy in the management of acute mechanical low back pain. NZ Med Journal, 98:372-375, 1985.

     

  18. Arkuszewski Z: The efficacy of manual treatment in low back pain: a clinical trial. Manual Medicine, 2:68-71, 1986.

     

  19. Waagen GN, Haldeman S, Cook G, Lopez D, DeBoer KF: Short term of chiropractic adjustments for the relief of chronic low back pain. Manual medicine, 2:63-67, 1986.

     

  20. Ongley MJ, Klein RG, Dorman TA, Eek B, Hubert LJ: A new approach to the treatment of chronic low back pain. Lancet, 2:143-146, 1987.

     

  21. Hadler NM, Curtis P, Gillings B, Stinnett S: A benefit of spinal manipulation as adjunctive therapy for acute low back pain: a stratified controlled trial. Spine, 12:703-706, 1887.

     

  22. Mathews JA, Mills B, Jenkins VM, Grimes AM, Morkel MJ, Mathews W, Scott CM, Sittampalam Y: Back pain and sciatica: controlled trials of manipulation, traction, and sclerosant and epidural injections. Br J Rheumatology, 26:416-423, 1987.

     

  23. Postacchini F, Facchini M, Palieri P: Efficacy of various forms of conservative treatment in low back pain: a comparative study. Neuro-Orthopedics, 6:28-35, 1988.

     

  24. Meade TW, Dyer S, Browne W, Townsend J, Frank AO: Low back pain of mechanical origin: Randomized comparison of chiropractic and hospital outpatient treatment. Brit Med Journal, 300:1431-1437, 1990.

     

  25. MacDonald RS, Bell; CM: An open controlled assessment of osteopathic manipulation in nonspecific low back pain. Spine, 15:364-370, 1990.

Controlled Trials of Manipulation for Neck Pain
  1. Nordemar R, Thorner C: Treatment of acute cervical pain: a comparative group study. Pain, 10:93-101, 1981.

     

  2. Howe DH, Newcombe RG, Wade MT: Manipulation of the cervical spine: a pilot study. Journal of the Royal College of General Practitioners, 33:574-579, 1983.

     

  3. Sloop PR, Smith DS, Goldenberg E, Dore C: Manipulation for chronic neck pain: a double-blind controlled study. Spine, 7:532-535, 1982.

     

  4. Brodin H: Cervical pain and mobilization. Int J Rehab Research, 7:190-191, 1984.

     

  5. Mealy K. Brennan H, Fenelon GCC: Early mobilization of acute whiplash injuries. Br Med Journal, 292:656-657, 1986.

Utah Study
Jarvis K, Phillips R, Morris, E: Cost per case comparison of back injury claims of chiropractic vs. medical management for conditions with identical diagnostic codes. Journal of Occupational Medicine, 33(8), August 1991.

Ebrall Study
Ebrall, P: Mechanical low back pain: A comparison of medical and chiropractic management within the victorian workcare scheme. Chiropractic Journal of Australia, 22(2), June 1992.

Keith Innes, D.C.
Scarborough, Ontario
Canada

January 1993
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