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CMT for Low Back Pain

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SMT is effective for acute, subacute, and chronic low back pain in adults [1]

A review conducted for the clinical practice guideline of the American College of Physicians and American Pain Society states that there is good evidence for moderate effectiveness of SMT for LBP of more than 4 weeks’ duration compared to placebo, sham or no treatment. They report fair evidence for small to moderate effectiveness of SMT for acute LBP. [2]

The 2007 clinical practice guideline from the American College of Physicians and the American Pain Society states that for patients who have not shown improvement with self-care, nonpharmacologic approaches with proven benefits should be considered. They recommend SMT for both acute and chronic LBP. [2]


  • A 2011 Cochrane review finds no clinically importance differences between SMT and other treatments for pain and functional improvement for chronic LBP. [3]
  • Regarding dosage (frequency of visits) for chiropractic management of chronic spine-related pain, it has been found that high-dose SMT has better very-short-term outcomes than low-dose SMT. [4]
  • Expert consensus recommends the following dosages for chronic spine-related pain: [5] [6]
  • 2-3 visits/week for 2-4 weeks.
  • Mild exacerbation: 1-6 visits; scheduled ongoing care 1-4 visits/month:[6]


  1. Bronfort, G et al (Feb 25 2010). "Effectiveness of manual therapies: the UK evidence report". Chiropr Osteopat 18 (1). Retrieved 1/11/2014. 
  2. 2.0 2.1 Chou, R et al (Oct 2 2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med 147 (7): 492-504. Retrieved 1/11/2014. 
  3. Rubinstein, SM et al (2011 Jun). "Spinal manipulative therapy for chronic low-back pain". Cochrane Database Syst Rev 36 (1). Retrieved 1/11/2014. 
  4. Bronfort, G et al (Jan-Feb 2008). "Evidence-informed management of chronic low back pain with spinal manipulation and mobilization". Spine J 8 (1): 213-225. Retrieved 1/11/2014. 
  5. Farabaugh, RJ et al (Sep 2010). "Management of chronic spine-related conditions: consensus recommendations of a multidisciplinary panel". J Manipulative Physiol Ther 33 (7): 484-492. Retrieved 1/11/2014. 
  6. 6.0 6.1 Globe, GA; Morris CE, Whalen WM, Farabaugh RJ, Hawk C. (Nov-Dec 2008). "Chiropractic management of low back disorders: report from a consensus process". J Manipulative Physiol Ther 33 (9): 651-658. Retrieved 1/11/2014.