Table 1 Recommendations of the Agency for Health Care Policy and Research on spinal manipulation for low back problems in adults*
From: Osteopathic research: elephants, enigmas, and evidence
Recommendation | Rating | Level of evidence |
|---|---|---|
Manipulation can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms. | B | Moderate research-based evidence |
When findings suggest progressive or severe neurologic deficits, an appropriate diagnostic assessment to rule out serious neurologic conditions is indicated before beginning manipulation therapy. | D | Panel interpretation of information that did not meet inclusion criteria as research-based evidence |
There is insufficient evidence to recommend manipulation for patients with radiculopathy. | C | Limited research-based evidence |
A trial of manipulation in patients without radiculopathy with symptoms longer than one month is probably safe, but efficacy is unproven. | C | Limited research-based evidence |
If manipulation has not resulted in symptomatic improvement that allows increased function after one month of treatment, manipulation therapy should be stopped and the patient re-evaluated. | D | Panel interpretation of information that did not meet inclusion criteria as research-based evidence |