Manipulative Therapies: What Works

 

Manipulative therapies include osteopathic manipulative treatment and many other forms of manual therapies used to manage a variety of conditions in adults and children. Spinal manipulative therapy may provide short-term improvement in patients with acute or chronic low back pain, comparable with other standard treatments. When compared with oral analgesics, cervical manipulation and/or mobilization appears to provide better short-term pain relief and improved function in patients with neck pain. Manipulative therapies may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intensity of pain. Although manipulative therapy is sometimes recommended to treat conditions in children (e.g., musculoskeletal problems, otitis media, respiratory conditions, infantile colic, allergies), there is supporting evidence only for reducing the length of hospital stay for preterm infants. Mild adverse events, such as muscle stiffness and soreness, occur in up to 50% of adults who undergo manipulative therapy. Although serious adverse events such as lumbar disk herniation, cauda equina syndrome, and vertebrobasilar injury are rare, they can cause significant disability or death. Given the limited proven benefits of manipulative therapies and small risk of serious adverse events, additional high-quality, adequately powered studies are needed before definitive recommendations can be made for treating many conditions.

Nearly one-third of the U.S. population uses some form of complementary and alternative medicine (CAM) in a given year.1 Osteopathic health care is used by nearly 16% of the U.S. population at some point in their lifetime.2 This article reviews the evidence on manipulative therapies including osteopathic manipulative treatment (OMT) for certain common medical conditions and the risks of adverse events related to its use.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Spinal manipulative therapy may be considered for patients with acute low back pain to provide modest improvement in pain and function at up to six weeks, comparable with other therapies.

B

810

Spinal manipulative therapy may be considered for patients with chronic low back pain. It results in modest improvement in pain and function for up to six months and is comparable with other therapies.

B

1113

Cervical manipulation and mobilization may be considered to provide short-term improvement in pain relief and function in patients with neck pain.

B

1416

Manipulative therapies are not recommended for treatment of childhood conditions such as acute otitis media, respiratory conditions, colic, or allergies.

B

5, 6, 20, 21

Mild adverse events of manipulative therapies are common. Serious adverse events are rare but can include vertebrobasilar injuries, lumbar disk herniations, cauda equina syndrome, and death.

B

6, 2224


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Spinal manipulative therapy may be considered for patients with acute low back pain to provide modest improvement in pain and function at up to six weeks, comparable with other therapies.

B

810

Spinal manipulative therapy may be considered for patients with chronic low back pain. It results in modest improvement in pain and function for up to six months and is comparable with other therapies.

B

1113

Cervical manipulation and mobilization may be considered to provide short-term improvement in pain relief and function in patients with neck pain.

B

1416

Manipulative therapies are not recommended for treatment of childhood conditions such as acute otitis media, respiratory conditions, colic, or allergies.

B

5, 6, 20, 21

Mild adverse events of manipulative therapies are common. Serious adverse events are rare but can include vertebrobasilar injuries, lumbar disk herniations, cauda equina syndrome, and death.

B

6, 2224


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The American Osteopathic Association defines OMT as the therapeutic application of manually guided interventions by a clinician to improve physiologic function or to support homeostasis that has been altered by somatic dysfunction.3  Types of OMT are summarized in Table 1. The rationale for osteopathic manipulation is based on the theory that the structure and function of the body

The Authors

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MICHAEL SETH SMITH, MD, PharmD, CAQ-SM, is an assistant professor in the Department of Community Health and Family Medicine and the Department of Orthopedics at the University of Florida in Gainesville....

JAIRO OLIVAS, MD, is a resident in the Department of Community Health and Family Medicine at the University of Florida.

KRISTY SMITH, MD, is an assistant professor in the Department of Community Health and Family Medicine at the University of Florida.

Address correspondence to Michael Seth Smith, MD, PharmD, University of Florida, 3450 Hull Rd., Gainesville, FL 32611 (e-mail: smithms@ortho.ufl.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

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