Chiropractic, Spinal Manipulative Therapy, Spinal Manipulation
Overview : Chiropractic is a health care discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) an...

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Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Tension headache: The use of spinal manipulative therapy for the relief of tension or migraine headache has been reported in several controlled human trials , systematic reviews , and case reports . Overall, the quality of studies is not high, with incomplete reporting of design, inconsistent use of techniques between studies, and variable results. Despite these methodologic problems, overall the evidence suggests some benefits in the prevention of episodic tension headache. Effects on migraine headache have not been demonstrated. Better quality research is necessary in this area before a firm conclusion can be drawn. Patients should be aware of the safety concerns surrounding cervical/neck manipulation before starting this type of therapy.
Grade: B

Low back pain (subacute or chronic): There are more than 150 published human trials and case reports that detail the use of chiropractic manipulation in patients with low back pain. Results are variable, with some studies reporting benefits, and others suggesting no significant effects. Most trials are not well designed or reported, with inconsistent use of definitions of disease, techniques, and measured outcomes. Several analyses (meta-analyses) have attempted to pool the results of the better-quality trials . However, combining or comparing results of different trials is difficult due to inconsistencies between studies, and these meta-analyses have also reported variable effects. Despite these problems with existing research, the available scientific evidence overall suggests some improvement in pain symptoms. Better research is necessary before a definitive conclusion can be reached.
Grade: B

Low back pain (acute): There is not enough reliable scientific evidence to conclude whether chiropractic techniques are beneficial in the management of acute back pain when compared to other approaches, including conservative management .
Grade: C

Migraine headache: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of migraine headache. There is limited human evidence in this area .
Grade: C

Lumbar disc herniation: Multiple studies have examined the effects of spinal manipulation in patients with herniated lumbar discs . Results are variable, with some studies reporting benefits, and others finding no effects. Various techniques, measurement systems, and study designs have been used, and overall the quality of studies has been poor. Better quality research is necessary before a firm conclusion can be drawn.
Grade: C

Neck pain (acute and chronic): Multiple studies have examined the effects of spinal manipulation in patients with acute or chronic neck pain . Overall, the quality of studies has been poor, and reviews of this topic have been unable to form clear or convincing conclusions due to variability between studies and methodologic weaknesses . Cervical spine manipulation and mobilization appear to have equal effects . Better quality research is necessary before a firm conclusion can be drawn.
Grade: C

Asthma: Several studies report the effects of chiropractic spinal manipulative therapy on breathing indices and quality of life in children and adults with asthma . Results are variable, and in the studies with positive results, mostly subjective but not objective (lung function test) changes are reported. Due to methodologic problems and variable results, no clear conclusions can be drawn in this area.
Grade: C

Carpal tunnel syndrome: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of carpal tunnel syndrome . Early evidence and some experts suggest that chiropractic manipulation may be as effective as conservative treatments such as anti-inflammatory drugs or splinting.
Grade: C

Cervical disc herniation: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of cervical disc herniation .
Grade: C

Chronic obstructive lung disease (COPD): There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of COPD .
Grade: C

Chronic pelvic pain: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of chronic pelvic pain (CPP) .
Grade: C

Duodenal ulcer: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of duodenal ulcer .
Grade: C

Dysmenorrhea (painful menstruation): There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of dysmenorrhea .
Grade: C

Fibromyalgia: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of fibromyalgia .
Grade: C

High blood pressure: The effects of spinal manipulative techniques on blood pressure remain controversial. It has been hypothesized that nervous system effects of spinal manipulation can lower both systolic and diastolic pressure. Numerous trials, reviews, and commentaries have been published in this area . Although some studies are suggestive, overall the existing evidence remains indeterminate due to methodologic weaknesses and variability between studies. Better research is necessary before a firm conclusion can be drawn. Nevertheless, caution should be used in patients with low blood pressure or taking medications that may lower blood pressure further.
Grade: C

HIV/AIDS: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques on CD4 count or quality of life in patients with HIV/AIDS .
Grade: C

Infantile colic: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of infantile colic .
Grade: C

Jet lag : There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of jet lag, and preliminary evidence suggests a lack of benefit .
Grade: C

Nocturnal enuresis (bedwetting): There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of nocturnal enuresis .
Grade: C

Otitis media: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of otitis media in children .
Grade: C

Parkinson's disease: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of Parkinson's disease .
Grade: C

Phobias: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of phobias .
Grade: C

Pneumonia: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of pneumonia in the elderly .
Grade: C

Premenstrual syndrome: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of premenstrual syndrome .
Grade: C

Respiratory tract infections: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques for respiratory tract infections .
Grade: C

Seizure disorder: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of seizure disorder .
Grade: C

Shoulder pain: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques for shoulder pain, frozen shoulder, or rotator cuff injuries .
Grade: C

Sprained ankle: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of ankle inversion sprains .
Grade: C

Temporomandibular joint (TMJ) disorders: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of TMJ
Grade: C

Visual field loss: There is not enough reliable scientific evidence to conclude the effects of chiropractic techniques for the recovery or prevention of visual field narrowing .
Grade: C

Whiplash injuries: Despite promising preliminary results, there is not enough reliable scientific evidence to conclude the effects of chiropractic techniques for the improvement of symptoms related to whiplash injuries .
Grade: C

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