RCT comparing spinal manipulation, Graston and Placebo for thoracic spine pain.

Chiroprac Man Ther May 2016.

 

This Australian study with 140+ patients was based on determining whether manipulation or Graston technique had a discernible benefit vs. placebo (nothing) in a randomized controlled setting. The conclusions not surprisingly showed no benefit at “any time point” vs placebo for thoracic spine pain. It was noted this was the first RCT of its kind comparing manipulation and Graston for TSP.

There were no differences noted at 1-3-6 or 12 months however ALL groups tended to improve over time (natural regression) including placebo-control group.

Studies which are well-controlled to reduce bias suggest manipulation has limited effects (long term) on pain or underlying pain generating mechanisms. A recent Cochrane systematic review of over 200 studies concluded: “spinal manipulation offered no benefit beyond that of any other standard treatment or no particular treatment. Further, given the common minor adverse side effects and potential for random catastrophic outcomes spinal manipulation cannot be recommended for treatment of any known condition”.

Fortunately these reviews, though seen by insurers and researches tend not to be accessed by the general public and their impact appears to be mitigated by the overall acceptance and enthusiasm manipulation enjoys. 

It should however make every DC aware that, though we tell ourselves otherwise, much of what we do is not proven or based in substantial scientific outcome-evidence.

Having a strong working knowledge of rehab (e.g. McGill etc) is a necessity when competing with PTs and evidenced-based medical rehab centers.

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