Particularly for low back pain, yes. The Medical Research Council conducted extensive research in chiropractic, comparing it with hospital outpatient management for the treatment of low back pain. In their report in the British Medical Journal of June 2nd 1990, the medical scientists stated that “… chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management”. The Clinical Standards Advisory Group recommended in 1994 that there should be earlier access to the manipulative therapies and a redistribution of resources within the NHS to make this happen. In September 1996 the Royal College of General Practitioners issued guidelines for GP’s which recommend manipulative treatment within the first six weeks for patients with low back pain. They also state that the risks of manipulation are very low in skilled hands.
Chiropractors mainly see patients with musculoskeletal problems. The majority of cases being back pain, followed by neck pain, limb pain and headaches. All of which are considered complex in terms of independent assessment, treatment and prognosis. Many practitioners use mechanical interventions and in the case of chiropractic, these include manual therapies. Manual therapies have been consistently endorsed in evidence-based guidelines in the UK since 1994 when the Clinical Standards Advisory Group made their recommendation. Although there are logical rationales for them, there is little direct scientific evidence that mechanics has anything to do with most of these complaints. However, the continuous evidence is that manual therapies are helpful and generally produce effective and sustained improvements for back pain. Although manipulation is an element of the chiropractic health profession, there are other elements to the chiropractic approach.
The NICE (National Institute for Health and Clinical Excellence) guidelines 2009 recommend manual therapy for patients with persistent non-specific back pain as provided by chiropractors, osteopaths and trained physiotherapists.
Initially a chiropractor will need to base their diagnosis on a full case history and examination they will then give advice on how to stay active, give adequate information and reassurance to the patient and then use manipulation if there is a rationale for it and if the patient is not returning to normal activities. It is the chiropractor’s responsibility, with the patients input, to decide on whether a treatment is likely to help or not and to change the approach or refer for other care if it is not working.