Is Manual Therapy Effective?

Manual therapy is a non-surgical form of conservative management that requires a range of professional hands/fingers-on techniques directed to the patient’s body (spine and extremities) for the purpose of evaluating, diagnosing and treating a variety of symptoms and conditions. Manual therapy is a wide range of methods that can be grouped into four main groups: a) manipulation (thrust manipulation), b) mobilization (non-thrust manipulation), c) static stretching, and d) muscle energy techniques. The definition and function of manual therapy varies among health professionals.

Spinal manipulation and mobilization are widely used in the treatment of back pain, especially by physical therapists, osteopaths and chiropractors. Back pain is an important health issue with severe social and economic implications for the developing world. It is projected that 80 percent of people in the US would encounter back issues at some point in their lifetime. Back pain is also very common in the United Kingdom, affecting about 29 per cent of the population every year.

In the Western World, the use of chiropractic, osteopathic and other forms of services offering different methods of manual therapy has gradually increased. For example in the United States, 33% of people with low back pain are treated with a chiropractor. The UK research investigated the prevalence of back pain and the use of chiropractic/osteopathy facilities in a randomly selected population of adults aged 18–64 years living in four counties in England. Of those surveyed with back pain (15.6 per cent), 13.4 percent met with osteopaths and/or chiropractors.

One descriptive review summarized surveys reporting rates of use of complementary and alternative medicine (CAM) treatment for low back pain and other musculoskeletal and non-musculoskeletal disorders. Results of this review found that chiropractors were used by 6% to 12% of the population studied, most of whom complained of back pain.

One descriptive review summarized surveys reporting rates of use of complementary and alternative medicine (CAM) treatment for low back pain and other musculoskeletal and non-musculoskeletal disorders. Results of this review found that chiropractors were used by 6% to 12% of the population studied, most of whom complained of back pain.

The annual incidence of significant harm or complications associated with the use of coercive procedures is poor. In general, handling using thrust techniques carries a higher risk of significant complications than non-thrusting, low-speed low-amplitude soft-tissue approaches. Systematic studies using a number of data sources come to contradictory conclusions about severe adverse effects that could result from spinal manipulation, in particular cervical manipulation (including stroke and death).