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Whenever I go in to see my chiropractor, I get the full works: usually three adjustments to different parts of my neck and back, a massage, and answers to all my questions about nutrition, supplements, pillows, and computer chairs. Sometimes I wonder if one of these treatment approaches is really all I need. Is it possible I would get well with just one adjustment? Or maybe just a massage without the adjustment? I'm probably obsessing but every time I go, these thoughts do roll around in my mind, so I thought I'd ask.

You aren't the only one who wonders about these things. With the high cost of health care, many medical practices (including chiropractic care) for low back pain have come under closer scrutiny. In a recent study, the type of combined treatment you describe that is usually offered in a chiropractic clinic is the focus. Combined treatment refers to the spinal manipulation along with patient education, massage, heat or cold, exercises, bracing, and pillows. Advice on nutrition and lifestyle changes are also part of the patient education piece. The researchers asked, does combined treatment work as well (or possibly better) than spinal manipulation alone? How does chiropractic care compare with other interventions? What short-, mid-, and long-term outcomes are seen with combined care? Are there any adverse effects of combined chiropractic care? And finally, how do the results of chiropractic care compare with having no treatment? Pain, disability, and general health status were used to measure progress. Studies included in the analysis had to describe patients in such a way that comparisons could be made between studies. The treatment or plan of care used had to be clear enough to make the same type of comparisons from one study to the next. This criteria was met in 12 of the studies reviewed. There was a total of 2887 low back pain patients in those 12 studies. Each study was a randomized controlled trial (RCT) meaning patients were assigned to treatment groups randomly (usually generated by a computer). After collecting all the data from the 12 studies and making comparisons, there simply wasn't a significant or measurable difference in results between combined chiropractic care and other interventions when used alone. Other interventions included heat, cold, massage, education, medications, bed rest, and exercise. Some patients got pain relief faster in the chiropractic care group at the start (short-term) but the improvement in pain over other treatment wasn't considered statistically significant. At the end (long-term), this edge was no longer present. That's pain, what about disability? Same story: no significant difference in disability at any point between combined chiropractic care and other treatment approaches. The final outcome measure (general health) was no different between combined chiropractic care and other types of care in the short- and mid-term. Long-term results weren't available in any of the studies published so far. That leaves rate of improvement and adverse effects. Once again, no difference in rate of improvement in the short-, mid-, or long-term. And no major or serious adverse effects of chiropractic care were reported. There were some cases of increased pain and other symptoms with chiropractic care but nothing was permanent or lasted more than a few hours to a few days. In summary, according to this systematic review, chiropractic care does not provide any long-term benefit over other types of conservative care in terms of pain relief, disability, or general health. Whether or not chiropractic care is better than no treatment has not been explored yet. Comparing a single manipulation with more than one and/or more than one manipulation along with other treatments would be important areas for future study.

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