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Spinal manipulation — usually administered by chiropractors and physical therapists — is one of several therapies recommended for patients with low back pain (NEJM JW Gen Med Apr 15 2017 and Ann Intern Med 2017; 166:514). In this meta-analysis of 26 randomized clinical trials, researchers evaluated the effects of spinal manipulation, compared with sham treatment or nonmanipulative therapies (e.g., analgesics, physical therapy), on pain and function in patients with acute low back pain (duration, ≤6 weeks) without radicular symptoms. No studies were blinded to providers, and few were blinded to patients.
At 6 weeks or less, moderate-quality evidence showed a modest, although statistically significant, association between spinal manipulation a…