Study Addresses Controversy of Spinal Adjustments by Physical Therapists

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The role of chiropractic in the medical treatment of back painLower back pain is a common condition often resulting in medical expenses and loss of work time. A common intervention is spinal adjustment, a technique practiced by chiropractors and physical therapists, among others. A spinal adjustment is a single, quick, and forcible movement following careful patient positioning. Previous studies have shown this treatment to be effective when performed by chiropractors. However, there has been little research on the use of spinal adjustments by other providers, such as physical therapists.

Although physical therapists commonly practice spinal adjustments, they have been challenged regarding whether this treatment falls within their scope of clinical practice. A recent study sought to examine the effectiveness of spinal adjustments for low-back pain when performed by physical therapists.

The authors of the study examined previous literature involving spinal adjustments performed by physical therapists on patients with low-back pain. Six randomized,controlled trials were reviewed. All involved a high-velocity, low-amplitude thrust technique applied to the lower back. The most common method to measure improvements was some variation of disability indexes and pain-rating scales.  Additionally, one study found statistically significant reductions in medication use, health-care utilization, and lost work time. In each of the studies, manipulative therapy provided by a physical therapist showed significant improvements over the comparative groups (which included no treatments, placebo or sham treatments).

Based on the findings of this systematic review, there is moderate evidence to support the use of spinal adjustments by physical therapists. It appears to be a safe intervention that improves clinical outcomes for patients with lower back pain. However, more research is needed to determine whether the effectiveness of spinal adjustments vary by practitioner type. Although the use of spinal adjustments by physical therapists continues to stir controversy among chiropractors, this research confirms the efficacy of  spinal adjustments for relieving back pain, thereby validating a treatment chiropractors have employed for years.

Previous research has also shown that combining chiropractic spinal adjustments with exercise therapy can significantly improve symptoms of back pain.


            Kuczynski J, Schwieterman B, Columber K, Knupp D, Shaub L, Cook C. Effectiveness of      physical therapist administered spnal manipulation for the treatment of low back pain: A      systematic review of the literature. International Journal of Sports Physical Therapy 2012;      7(6): 647-662.

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