Spinal Therapy for Low Back Pain: 33 Vertebral Joints, Which Is The Best to Crack? Evidences Up to 2023
Spinal manipulation therapy (SMT) has existed since thousands of years ago, dating back to ancient Greece in 400 BC. Hippocrates, the father of Western medicine, once said “Look well to the spine for the cause of disease”.
Who Uses SMT to Treat Patients Today?
SMT may be used by any one who wants to treat musculoskeletel conditions, including medical doctors, osteopath doctors, physiotherapists and chiropractors. In America, chiropractors conduct 94% of all spinal manipulations, according to a RAND Corporation's report.
33 Joints, Countless Diseases: Which Treats Which?
SMT has been there for at least 2600 years. In the spine, there are 33 vertebral joints. When we treat a specific condition, do we work on all of these joints, or use a specific joint which we know works best?
A 2023 Review on SMT for Low Back Pain
In 2023, 4 researchers from Denmark, 2 PT, 2 DC, published a systematic review which examined whether SMT targeting a specific vertebral level produces better outcomes than random SMT for low back pain (Westlund S P et al, 2023). Data were searched up to May 31, 2023.
Findings
10 RCTs (n = 931 patients) were included. There was moderate-certainty evidence of no difference between targeted SMT and a nontargeted approach for pain intensity at post-intervention and at follow-up. For patient-reported disability, there was moderate-certainty evidence of no difference at post intervention and at follow-up. Adverse events were reported in 4 trials, and were minor and evenly distributed between groups.
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Authors' Conclusions
Targeting a specific vertebral level when administering SMT for patients with nonspecific low back pain did not result in improved outcomes on pain intensity and patient-reported disability compared to a non-targeted approach.
Deep Thinking
33 vertebral joints, the best one to crack to cure low back pain? We have no clue. We humankind today can send a man intact and safely from the earth to the moon with 3 days. The moon is about 390,000 kilometers away from us, which is a distance around 10 times the circumference of the Earth. With today's science and technology, we can place a spacecraft exactly on the lunar orbit and place a man on a spot on the surface of the moon as we calculated in our planning.
There are only 33 but not thousands of joints in our 60 -70 cm long spine. We have been touching the spine with our hands for thousands of years in clinical practice: palpating, rubbing, kneading, twisting, cracking or popping it every day, but we still do not have a clue on which joint may best treat which specific disease. Can we dare to dream of a magic bullet at least for low back pain?
References
Westlund S P et al, Spinal Manipulative Therapy for Nonspecific Low Back Pain: Does Targeting a Specific Vertebral Level Make a Difference? ... J Orthop Sports Phys Ther 2023;53(9):529-539.
#spinaltherapy spinalmanipulation #smt #vertebraljoints #lowbackpain
Firstly,it is surprise,because the ancient chinese philosopher zhuangzi,had this similar finding with Hippocrates. Trying to locate the special joints to leverage is a clever way. However,the research done in denmark looks unconvincing. To locate a specific point to a specific condition,is just the object of the game,not the path(no one knows where they are yet),so how did the outcomes come? I am also a researcher on this subject. Besides,backpain is a large concept,a research done simply would hardly lead to a conclusion which is full range.