In his brief summary for WorkSafeBC (Chiropractic treatment for injured workers, BCMJ 2013;55:432-433 [9]) 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

References

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.