Letters to the Editor

Spinal Manipulative Therapy in the Treatment of Low Back Pain


Am Fam Physician. 2008 Mar 15;77(6):746.

to the editor: The review of the evidence in the article “Evaluation and Treatment of Acute Low Back Pain” is succinct and laudable.1 However, one implication should be corrected to avoid engendering further confusion on an already hotly debated topic.

In the “SORT: Key Recommendations for Practice” table, Dr. Kinkade accurately states: “Spinal manipulative therapy for acute low back pain may offer some short-term benefits but probably is no more effective than usual medical care.”1 However, the implication that spinal manipulation shows improvements when compared with sham or ineffective treatments, but does not show any benefit when compared with usual care, could be misleading. The articles Dr. Kinkade cited in support of this recommendation clearly show that although spinal manipulation did not yield superior outcomes compared with usual care, it did produce equivalent benefits.25

I encourage physicians to review the literature on this topic published in past issues of American Family Physician as well as articles published in other journals. For example, an article in the November 2004 supplement of the JAOA-Journal of the American Osteopathic Association summarizes the results of the three major clinical trials suggesting the potential utility of osteopathic manipulative treatment in acute and chronic low back pain.6

The phrasing in Dr. Kinkade's article could potentially mislead physicians and may prevent physicians who use spinal manipulation in their practices from obtaining reimbursement for this procedure.

Author disclosure: Nothing to disclose.


show all references

1. Kinkade S. Evaluation and treatment of acute low back pain. Am Fam Physician. 2007;75(8):1181–1188....

2. Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004;(1):CD000447.

3. Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J. 2004;4(3):335–356.

4. Ferreira ML, Ferreira PH, Latimer J, Herbert R, Maher CG. Efficacy of spinal manipulative therapy for low back pain of less than three months' duration. J Manipulative Physiol Ther. 2003;26(9):593–601.

5. van Tulder MW, Koes B, Malmivaara A. Outcome of non-invasive treatment modalities on back pain: an evidence-based review. Eur Spine J. 2006;15(suppl 1)S64–81.

6. Licciardone JC. The unique role of osteopathic physicians in treating patients with low back pain. J Am Osteopath Assoc. 2004;104(11 suppl 8):S13–18.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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