Lower back pain (LBP) is a common and costly musculoskeletal problem, affecting about 80% of all persons at some time in their lives. Many people with this condition seek the care of a chiropractor who may utilize a range of interventions such as spinal manipulation, massage, electrotherapy, mechanical devices, exercise, orthotics, and others. A recent large study found that chiropractic was effective in treating both acute and chronic LBP; however, there were considerable limitations of this study that question its external validity.
For this prospective cohort study adult patients with LBP who had not received chiropractic or manual therapy in the prior 3 months were recruited from multiple chiropractic practices in Switzerland [Peterson et al. 2012]. Patients were excluded if they had specific lumbar spine pathologies that are relative contraindications to chiropractic manipulative therapy, including tumors, infection, inflammatory spondyloarthropathies, fractures, severe osteoporosis, and Paget’s disease (bone deformities).
The purpose of the study was to evaluate outcomes in routine practice, so the 44 chiropractors volunteering to participate were allowed to administer their typical treatment methods (such as spinal manipulation, soft tissue mobilization, or others). Patients completed a numerical pain rating scale (NRS) and the Oswestry disability questionnaire at baseline immediately before treatment, and at 1 week, 1 month, and 3 months after the start of treatment. Subjects also self-reported perceived improvement on a Patient Global Impression of Change (PGIC) scale.