Study claims spinal manipulation 'doesn't work'

Studies into spinal manipulation (SM) had failed to demonstrate that it was an effective intervention for a series of complaints, according to research to be published in next month's Journal of the Royal Society of Medicine.

A team from the Peninsula Medical School in Exeter, Devon, looked at 16 academic papers on SM where it was practiced for conditions such as back pain and neck pain, as well as asthma and other allergies.

They concluded that SM was only effective for back pain where it was superior to "sham" manipulation but not better than conventional treatments. Considering the possibility of adverse effects, they said, the review did not suggest that SM was a recommendable treatment.

"There is little evidence that spinal manipulation is effective in the treatment of any medical condition," said Professor Edzard Ernst, of the Peninsula Medical School.

Spinal manipulation is commonly practiced by chiropractors and osteopaths and is a popular type of manual treatment for back and neck pain, with an estimated 16,000 licensed chiropractors in the UK.

'Risk-benefit balance'

Prof Ernst's study examined all systematic reviews published on SM between 2000 and May 2005. He said the findings confirmed fears that in "alternative" medicine, regulation often served as a substitute for research.

"Previous studies have shown that regulation of chiropractors was followed by a decrease in research activity," said Prof Ernst. "The evidence presented here should be seen as a wake-up call to the chiropractic profession.

"One way forward is more rigorous clinical trials to test the efficacy of spinal manipulation. After all, the treatment is not without risk and chiropractors must demonstrate why it should be a recommendable medical treatment option."

The research review claimed that SM has been associated with "frequent, mild adverse effects" as well as "serious, probably rare implications."

"Therefore the risk-benefit balance does not favour SM over other treatment options such as therapeutic exercise," said the report. "This statement is not in agreement with several national guidelines…but we suggest that these guidelines be reconsidered in the light of the best available data available."

Study 'disappointing'

The General Osteopathic Council (GOsC) hit back today claiming that the opinion of Professor Ernst was "out of date" and that his review was "limited in terms of scientific value."

The GOsC said that research was a "high priority" within the osteopathic profession, so any new research that was published was "very welcome" and of interest. However, it described the contribution from Prof Ernst as "disappointing".

A spokesperson for the Council said: "A substantial amount of research has been carried out in the last few years by the osteopathic profession, most particularly a Medical Research Council (MRC) funded trial on spinal manipulation and exercise therapy for low back pain.

"This important study provides good evidence to support spinal manipulation for low back pain, particularly when combined with exercise guidance - this is typical osteopathic management. This suggests that Professor Ernst is out of date with this review, a recognised problem when researching secondary data."