Re: Spinal manipulation in low back pain

In his brief summary for WorkSafeBC (Chiropractic treatment for injured workers, BCMJ 2013;55:432-433) Dr Jeffrey Quon provides two (and curiously only two) references to support the benefits of spinal manipulation in low back pain.

The first is a summary of worldwide practice guidelines, including guidelines from chiropractic groups, for therapy of low back pain, assembled by authors from a private, for-profit, chiropractic clinic in Buffalo, New York.[1] It is not difficult to suppose this review may have some minor bias.

The other reference is to a recent Cochrane review[2] on spinal manipulation in chronic low back pain (not acute pain after injury, as Dr Quon’s title would suggest). The key sentence in the summary of this review is “… SMT (spinal manipulation therapy) has a small, statistically significant but not clinically relevant, short-term effect on pain relief . . . and functional status… compared to other interventions.”

Hardly enthusiastic support for spinal manipulation covered by WorkSafeBC.
—Roy Preshaw, MD
Telegraph Cove


1.    Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010:10:514-529.
2.    Rubinstein SM, van Middelkoop M, Assendelft WJJ, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev 2011;16:CD008112.

R.M. Preshaw, MD. Re: Spinal manipulation in low back pain. BCMJ, Vol. 56, No. 1, January, February, 2014, Page(s) 8 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply