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102 APPENDICES Physiotherapy KCE reports vol. B
Conclusion
There is moderate evidence that spinal manipulative treatment/mobilization is more effective than no treatment to treat
low back pain.
There is moderate evidence that spinal manipulative treatment is as effective as more traditional treaments such as
efficacious NSAID, GP care, physical therapy, exercise and back schools to treat acute, sub acute and chronic and/or
recurrent low back pain.
There is little and sometimes conflicting evidence on safety of manipulative treatment for low back pain. Minor secondary
effects (headache, fatigue sensation, general transient unwellness state and/or pain enhancement) seem frequent and self
limiting. Major complications (stroke due to vertebro-basilar artery dissection, herniated discs, cauda equina syndrome)
seem very uncommon but potentially dramatic.
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