Just last week, the BMJ – one of the world’s most prestigious medical journals – published that spinal manipulation (synonymous with chiropractic adjustments) works as good as other recommended therapies for low back pain. What does this mean for you as a pain sufferer?


Earlier this month, the BMJ – one of the world’s most prestigious medical journal – published its endorsement for spinal manipulation. What does this mean for you and your chiropractor?

I am sure chiropractors all around the world are super stoked to have the BMJ endorsing spinal manipulation. (Did they though?) After all, most people associate chiropractors with spinal manipulation. But what does this paper really mean and how does it sit within the context of evidence-based care?

First, the paper acknowledged that spinal manipulation is NOT the first line treatment for chronic low back pain.

Second, at both one month and 12-months, spinal manipulation had no clinical effect for pain when used as an adjunct therapy.

Third, at both one month and 12 months, spinal manipulation was not statistically (or clinically) better than other recommended treatments.

Most important of all, the study only looked at chronic low back pain and the improvement in function is only for the short-term. I.e. there is no long-term improvement in function and also the chronic low back pain sufferers probably did not experience an improvement in pain.

So in conclusion, spinal manipulation is useful in short-term improvement in function but it is not a viable treatment option for long-term improvement. When it comes to pain, spinal manipulation is not useful in both the short and long-term.

What do I do about my low back pain then?


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What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high quality clinical practice guidelines: systematic review.

Let’s not get tunnel visioned! If we look at the paper discussed in our previous entry, the eleven recommendations that are consistent across musculoskeletal pain conditions recommended for manual therapy to be used as an adjunct treatment.

Doesn’t it make sense now? Despite the latest study on spinal manipulation seeming to support chiropractic adjustments as a viable low back treatment, it really is not. When compared against other recommended treatments or when used as an adjunct, spinal manipulation does not perform well for pain relief. It is at best a temporary solution to increase function.

What is the best evidence low back pain treatment then?


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Evidence-Based Care: Lancet Recommendations for Acute and Chronic Low Back Pain

Well, the most recent international guidelines by Lancet made four first-line treatment recommendations for chronic low back pain. They are:

1. Advice to remain active

2. Education

3. Exercise therapy

4. Cognitive therapy

What do they say about spinal manipulation? Second-line treatment option or to be used as an adjunct.

So there you go. This is what the BMJ is really saying and it is congruent with other international guidelines. No, the medical journal is not endorsing chiropractic adjustments as a long-term solution for your chronic pain.

Square One vs. other chiropractors in Singapore

We are the first exercise-based chiropractic clinic in Singapore and we are also the only chiropractor who does not adjust all of our clients. The difference? We offer front-line best evidenced care. We are willing to do what it takes so you can get the best results! We constantly keep ourselves updated with the latest research findings. We have a good understanding of existing literature. We make good, best-evidence clinical decisions so you can go back to doing what you love. Drop us a message to find out how we can help you.