Chiro Nexus recently listed the top 10 chiropractic studies of 2013.
In my experience, chiropractic studies tend to be of poor quality.
Underlying hypothesis: If the motion of zygapophyseal joints is decreased for any reason (inactivity, repetitive motion, injury), it is hypothesized that they develop adhesions and that both spinal manipulation therapy (SMT) and side-posture positioning (SPP) break the adhesions by “gapping” the joints (separating the articular surfaces, the same process that happens when you crack your knuckles).
Methods: 112 patients with low back pain were randomized to four treatment groups: SMT, SPP, SMT control, SPP control.
First MRI appointment: Patients were placed in a neutral position prior to treatment; the most painful side was always the up side for treatment.
An MRI was taken in the neutral position before treatment, then treatment was given followed by a post-treatment MRI. Treatment phase: All patients received chiropractic care for 2 weeks, including SMT and other modalities.
This study attempted to show that the improvement is related to increased gapping of the zygoapophyseal joints, but the authors suggest that muscle relaxation may be the mechanism for both increased gapping and decreased pain, raising the question of whether SMT actually accomplishes anything that other muscle relaxing treatments might not do just as well.
Basically, before chiropractic treatment, a single SPP treatment increased gapping more than SMT, and after 2 weeks of SMT treatment, a single SMT treatment increased gapping compared to a single SPP treatment.
It would be nice to find out if the hypothesized adhesions are real, but the study didn’t address that. It is a patient information page from the Many treatments are available for low back pain. Some people benefit from chiropractic therapy or acupuncture.
Sometimes medications are needed, including analgesics (painkillers) or medications that reduce inflammation.
The suggestion of keeping the patient in a side position following SMT is interesting, but this study was not designed to show whether that would improve clinical outcomes.