Spinal manipulation is effective for back pain

Dear Editor

I am writing regarding your article on the evidence of effects of spinal manipulation (GP, 10 November 2006).

The General Chiropractic Council’s (GCC’s) code of practice requires chiropractors to provide evidence-based care to their patients.

There is good evidence, derived from research funded by the Medical Research Council, that the chiropractic management of back pain is effective in terms of outcome and cost. Cochrane concurs.

Chiropractic management of back pain involves a package of care including lifestyle advice, exercise, psychosocial factors and, where necessary, manipulation. This is supported by a number of national and international good practice guidelines formulated by inter-disciplinary teams of experts.

Chiropractors employ a range of manipulative techniques. It is facile to define the chiropractic and osteopathic professions in the context of a single manipulative technique when they have such an extensive range of skills.

Those chiropractors who find it clinically necessary to use X-rays must be competent to do so and comply with the radiation regulations — just like any other health professional.

While every human activity carries some risk, chiropractic is a safe, effective treatment for back pain. There is no evidence that chiropractic manipulation of the neck causes stroke, and to imply that there is a causal relationship is misleading and purely speculative.

The GCC is saddened that Professor Ernst continues to muddy the waters. His views do not reflect current chiropractic practice or evidence, nor has he accurately conveyed the GCC’s position.

Furthermore, the Cochrane review found that manipulation administered alongside an exercise programme was of greater benefit than manipulation or mobilisation alone. It did not find that spinal manipulation was of ‘no benefit’ for neck pain as stated by Professor Ernst.

The point is that effective management of back pain requires a package of care — there is no ‘silver bullet’.

Peter Dixon

Chairman, General

Chiropractic Council

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