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Spinal manipulation doesn’t work?

The Journal of the Royal Society of Medicine has just published a paper claiming, controversially, that spinal manipulation (rather unfortunately abbreviated to SM here) as used by chiropractors, osteopaths, and physiotherapists doesn’t work for any medical condition.

The paper, which is a “review of reviews”, is by Edzard Ernst and P.H.Canter. Professor Ernst is a controversial figure in CAM circles because he generally rubbishes most CAM treatments, as here.

The authors looked at sixteen reviews published between 2000 and May 2005 and concluded that “Overall, there is little evidence in recent systematic reviews that SM is effective in any medical condition… the demonstrable benefit of SM seems to be minimal in the case of acute or chronic back pain; controversial in the case of headache; or absent for all other indications.”

Spinal manipulation is reported to produce frequent mild adverse effects and rare serious effects, so Ernst and Canter think that other treatments, such as exercises, should be used instead.

The authors do admit that absence of evidence is not the same as evidence of absence, but they think that more rigorous methodological studies are needed before spinal manipulation is recommended as a good form of treatment.

Osteopathy and chiropractic are now regulated by statute in Britain. Patients and the public may think that this means that there is now official proof that they work, Ernst and Canter say. Regulation may have led to a reduction in research.

This paper will certainly be seized on by critics of CAM as further evidence of its ineffectiveness, but CAM is becoming increasingly popular. There is a wide gap between what patients experience and what research evidence supports. Spinal manipulation is not unique in this respect. The same is true of acupuncture, TENS (transcutaneous nerve stimulation), and homeopathy, for example.

Advocates of CAM will say that it is the research methods that are at fault. I don’t see any end to the controversy myself.

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