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J Chiropr Med. 2016 Sep;15(3):165-83. doi: 10.1016/j.jcm.2016.04.014. Epub 2016 May 25.

Spinal Manipulation Vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-analysis.

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Private Practice, Align Body Clinic, Bath, UK.
MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK; Centre for Academic Mental Health, School of Social and Community Medicine University of Bristol, Bristol, Bristol, UK.
The NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.



The purpose of this systematic review was to identify and critically evaluate randomized controlled trials of spinal manipulation (SM) vs sham manipulation in the treatment of nonspecific low back pain.


Four electronic databases were searched from their inception to March 2015 to identify all relevant trials. Reference lists of retrieved articles were hand-searched. All data were extracted by 2 independent reviewers, and risk of bias was assessed using the Cochrane Back Review Group Risk of Bias tool.


Nine randomized controlled trials were included in the systematic review, and 4 were found to be eligible for inclusion in a meta-analysis. Participants in the SM group had improved symptoms compared with participants receiving sham treatment (standardized mean difference = - 0.36; 95% confidence interval, - 0.59 to - 0.12). The majority of studies were of low risk of bias; however, several of the studies were small, the practitioner could not be blinded, and some studies did not conduct intention-to-treat analysis and had a high level of dropouts.


There is some evidence that SM has specific treatment effects and is more effective at reducing nonspecific low back pain when compared with an effective sham intervention. However, given the small number of studies included in this analysis, we should be cautious of making strong inferences based on these results.


Low back pain; Manipulation; Placebo; Review of the literature; Spinal

[Available on 2017-03-01]

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