Spinal manipulative therapy is one of the most commonly used treatments for patients with low back pain. It is both a manual diagnostic and a treatment method. Manual diagnosis includes the palpation of vertebral position, vertebral motion, joint play, end feel, soft tissue texture changes, and muscle contracture. Manipulative treatment can be divided into seven categories: long-lever, nonspecific manipulation; specific, short-lever high-velocity spinal adjustments; active or functional manipulation; mobilization; manual traction; soft tissue massage; and point pressure manipulation. Clinical experience with manipulation for low back pain is extensive, and controlled observations show that it is possible to produce immediate relief of pain in some cases. The effectiveness of manipulation is greatest in patients who have acute pain and no leg pain or neurologic deficits. Long-term effects of manipulation have not been demonstrated. Manipulation appears to increase spinal range of motion and straight leg raising but is not known to reduce intervertebral disc herniations. Complications following manipulation, although rare, can be catastrophic.
Veterans Administration Medical Center, Long Beach and the Department of Neurology, University of California at Irvine, California.