Date: 23/09/2019
Yes we do – plenty:
Evidence-based care for the effectiveness of manual therapies
The Bronfort Report (commissioned by the General Chiropractic Council and published on 25 Feb 2010). Professor Gert Bronfort independently looked into the research supporting the effectiveness of Chiropractic Treatment. To do this he performed systematic reviews of Randomised Controlled Trials (RCTs), and UK and USA Clinical Guidelines, focussing on both musculoskeletal and non-musculoskeletal conditions.
The results of his review concluded that there is evidence-based research that Chiropractic Care is effective for the treatment of the following conditions:
- Cervicogenic dizziness, headaches, and migraine
- Acute /subacute, and chronic neck pain
- Shoulder girdle pain/ dysfunction
- Adhesive capsulitis
- Lateral epicondylitis (tennis elbow)
- Acute and chronic lower back pain
- Hip osteoarthritis
- Knee osteoarthritis
- Patellofemoral pain syndrome
- Plantar fasciitis
UK research specific to Lower Back Pain
1978 – The first UK government report
1994 – Clinical Standards Advisory Group report which advised to shift resources into primary care; early active treatment; manipulation and not to refer simple back pain to orthopaedics/rheumatology.
1995 – Medical Research Council trial in which there were 1334 participants that manipulative care was significantly superior to NHS outpatient care at both 3 and 12 months.
1996 – Royal College of General Practitioners NHS guidelines for treating back pain suggest manipulation if the patient is struggling to return to work.
1999 – Royal College of General Practitioners/ NHS guidelines for treating lower back pain are: remain active, manipulative care and assess for yellow flags.
Manipulative care was shown to have:
- A strong evidence base (19 RCT trials)
- Provides improvement in pain and function
- Has a high patient satisfaction
2000 NICE Report on the management of patients with chronic (longer than 6 weeks) non-specific lower back pain.
These guidelines state that GPs should promote patient choice and early intervention should include either
A course of manual therapy to include manipulation 9 sessions over 12 weeks
A course of structured exercises
A course of acupuncture 10 sessions over 12 weeks
2002 European Guidelines for the management of acute non-specific lower back pain manipulation is the only form of active manual intervention that is recommended.
2009 National Institute of Clinical Excellence (NICE) guidelines for the treatment of non-specific lower back pain published in May 2009 states in its principles of patient management that on presentation patients should be offered one of the following:
- An exercise program.
- A 12-week course of manipulation/mobilisation
- A 12-week course of needling (acupuncture)
It is evident from the research over the last 25 years that early treatment of the spine for pain/dysfunction should include manipulative care.
The Chiropractic Team at New Forest Clinics not only specialises in manipulation as they are also trained in:
- Massage
- Mobilisation
- Exercise programs
- Stretching
- Advice and patient education
- Dry needling
- SOT (Sacro-occipital Technique)
- Modalities
Exciting New Research: Suggesting that Uneven Motion Sharing in the Lumbar Spine is a Biomarker for non-specific lower back pain.
Co-author Alan Breen, Ph.D., professor of Musculoskeletal Research at Bournemouth University in Poole, UK, commented to OTW, “We were investigating the possibility of there being personalized biomechanical markers for nonspecific back pain, which is the world’s largest cause of lifetime disability.”
“Uneven intervertebral motion sharing is related to disc degeneration and is greater in patients with chronic, non-specific low back pain: an in vivo, cross-sectional cohort comparison of intervertebral dynamics using quantitative fluoroscopy,” appears in the January 2018 edition of the European Spine Journal.