March 1996

Most orthopedic surgeons have been suspicious, even disbelieving, of the beneficial effects of spinal manipulation for back pain. Some consider this type of chiropractic to border on charlatanry. Recommendations contained in the Agency for Health Care Policy and Research's Clinical Practice Guideline for Acute Low Back Problems in Adults have renewed interest in the spinal manipulation debate. Recent reports in the medical literature have heralded the benefits of manipulation compared to physical therapy, and increasing numbers of insurers and HMOs are covering visits to chiropractors. All seem to indicate that spinal manipulation is gaining in scientific and practical acceptance. However, some spine surgeons are concerned about the lack of a true definition for spinal manipulation beyond "the laying on of hands to move the spine for the benefit of the patient," and that the literature supporting the procedure's efficacy describes various techniques used in different situations with outcomes measured at differing lengths of time.

In our Counterpoints this month, two former presidents of the North American Spine Society present their opposing viewpoints on spinal manipulation. It is obviously very difficult to make such a comparison, even in a prospective study, when the results are so subjective and influenced by so many subjective and emotional variables. Perhaps the reader can draw his own conclusion from these opinions.


Point-Counterpoint

Spinal Manipulation: How Did It Get So Accepted?
   by Scott Haldeman, MD, PhD


Acute Back Pain Treatment Rationale Should Be Clear
   by Vert Mooney, MD


Copyright 1996, SLACK Incorporated. Revised 13 March 1996.