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BMJ Open 2021 11 29;11(11):e057112. Epub 2021 Nov 29.

Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia.

Introduction: Chronic low back pain disorders (CLBDs) present a substantial societal burden; however, optimal treatment remains debated. To date, pairwise and network meta-analyses have evaluated individual treatment modes, yet a comparison of a wide range of common treatments is required to evaluate their relative effectiveness. Using network meta-analysis, we aim to evaluate the effectiveness of treatments (acupuncture, education or advice, electrophysical agents, exercise, manual therapies/manipulation, massage, the McKenzie method, pharmacotherapy, psychological therapies, surgery, epidural injections, percutaneous treatments, traction, physical therapy, multidisciplinary pain management, placebo, 'usual care' and/or no treatment) on pain intensity, disability and/or mental health in patients with CLBDs. Read More

Front Physiol 2020 24;11:592. Epub 2020 Jun 24.

Department of Sport and Health Sciences, Technical University Munich, Munich, Germany.

Aging is a one-way process associated with profound structural and functional changes in the organism. Indeed, the neuromuscular system undergoes a wide remodeling, which involves muscles, fascia, and the central and peripheral nervous systems. As a result, intrinsic features of tissues, as well as their functional and structural coupling, are affected and a decline in overall physical performance occurs. Read More

Complement Ther Clin Pract 2020 May 3;39:101115. Epub 2020 Feb 3.

The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China. Electronic address:

Background And Purpose: Cervical vertigo (CV), one of the most common causes of vertigo, makes patients feel dizzy, which seriously affects patients' lives. As a traditional Chinese bone-setting manipulation, Tuina is widely used to treat CV. This article aims to evaluate the effectiveness and safety of Tuina for CV. Read More

J Gen Intern Med 2020 03 28;35(3):775-783. Epub 2019 Oct 28.

VA Health Services Research & Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.

Background: Potential protective effects of nonpharmacological treatments (NPT) against long-term pain-related adverse outcomes have not been examined.

Objective: To compare active duty U.S. Read More

Int J Ther Massage Bodywork 2018 Mar 26;11(1):11-16. Epub 2018 Mar 26.

School of Health Professions, Rutgers University, Newark, NJ, USA.

Introduction: Massage techniques fall within the scope of many different health care providers. Physical therapists, occupational therapists, and chiropractors receive insurance reimbursement for health care services, including massage. Although many patients pay out of pocket for massage services, it is unclear how the insurance company reimbursement policies factor provider qualifications into coverage. Read More

Eur Spine J 2018 09 19;27(Suppl 6):851-860. Epub 2018 Feb 19.

Division of General Medical Rehabilitation, University of Geneva, Geneva, Switzerland.

Purpose: The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain.

Methods: We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries. Read More

J Manipulative Physiol Ther 2018 Nov - Dec;41(9):771-779

College of Traditional Chinese Medicine, Jinan University, Guangzhou, Guangdong Province, China. Electronic address:

Objective: The purpose of this review was to compare oblique pulling spinal manipulation with other treatments for lumbar disc herniation.

Methods: Randomized controlled trials of oblique pulling manipulation versus other treatment for lumbar disc herniation were identified using the following databases: China National Knowledge Infrastructure, Wanfang Data, Chinese Science and Technology Periodical Database, PubMed, the Cochrane Library, Embase, Chinese Biological Medicine, and Web of Science. Data extraction was carried out based on inclusion and exclusion criteria, and meta-analysis were performed using RevMan 5. Read More

Explore (NY) 2016 May-Jun;12(3):215-7. Epub 2016 Mar 2.

Unlabelled: FURLAN AD, GIRALDOM, BASKWILL A, IRVIN E, IMAMURA M. MASSAGE FOR LOW-BACK PAIN. COCHRANE DATABASE SYST REV 2015, ISSUE 9. Read More

Eur Spine J 2016 07 16;25(7):2000-22. Epub 2016 Mar 16.

, Toronto, Canada.

Purpose: To develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD).

Methods: This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Read More

Cochrane Database Syst Rev 2015 Sep 1(9):CD001929. Epub 2015 Sep 1.

Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, Canada, M5G 2E9.

Background: Low-back pain (LBP) is one of the most common and costly musculoskeletal problems in modern society. It is experienced by 70% to 80% of adults at some time in their lives. Massage therapy has the potential to minimize pain and speed return to normal function. Read More

J Jpn Phys Ther Assoc 2014 ;17(1):31-38

Occupational Health Service, Correos Group of Valencia Pza. Ayuntamiento, 24. PC: 46002 Valencia, Spain.

Background: Tension-type headache (TTH) is a disease with a great incidence on quality of life and with a significant socioeconomic impact.

Objectives: The aim of this review is to determine the effectiveness of physical therapy by using manual therapy (MT) for the relief of TTH.

Data Sources: A review was done identifying randomized controlled trials through searches in MEDLINE, PEDro, Cochrane and CINAHL (January 2002 - April 2012). Read More

J Manipulative Physiol Ther 2014 Jan 19;37(1):42-63. Epub 2013 Nov 19.

Chiropractor, Markham, Ontario, Canada.

Objective: The purpose of this study was to develop evidence-based treatment recommendations for the treatment of nonspecific (mechanical) neck pain in adults.

Methods: Systematic literature searches of controlled clinical trials published through December 2011 relevant to chiropractic practice were conducted using the databases MEDLINE, EMBASE, EMCARE, Index to Chiropractic Literature, and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, weak, or conflicting) and to formulate treatment recommendations. Read More

Cochrane Database Syst Rev 2013 Jan 31(1):CD000447. Epub 2013 Jan 31.

Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, Leiden, Netherlands, 2300 RC.

Background: Low-back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low-back pain.

Objectives: To resolve the discrepancies related to the use of spinal manipulative therapy and to update previous estimates of effectiveness, by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis. Read More

Prim Care 2012 Sep;39(3):511-6

Southern Regional AHEC, 1601 Owen Drive, Fayetteville, NC 28304, USA.

Physical therapy and manual medicine for low back pain encompass many different treatment modalities. There is a vast variety of techniques that physical therapists commonly use in the treatment of low back pain. Some of the therapies include, but are certainly not limited to, education, exercise, lumbar traction, manual manipulation, application of heat, cryotherapy, and ultrasonography. Read More

Clin Rehabil 2012 Nov 3;26(11):963-73. Epub 2012 Apr 3.

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.

Objective: To assess whether Chinese manipulation improves pain, function/disability and global perceived effect in adults with acute/subacute/chronic neck pain.

Data Sources: CAJ Full-text Database (Chinese), Wanfang Database (Chinese), Cochrane Database (English) and Medline (English).

Review Methods: Literature searching was performed with the following keywords and their combination: 'manual therapy/bone setting/Chinese manipulation', 'neck/cervical pain', 'cervical vertebrae', 'cervical spondylosis/radiculopathy' and 'randomized controlled trial/review. Read More

Am Fam Physician 2012 Feb;85(4):343-50

University of North Carolina School of Medicine, Chapel Hill, NC, USA.

Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underlying pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Read More

BMJ Clin Evid 2011 Jun 28;2011. Epub 2011 Jun 28.

Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK.

Introduction: Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30 to 50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc. Read More

BMJ Clin Evid 2011 May 9;2011. Epub 2011 May 9.

CBI Health Group Research Dept, Toronto, ON, Canada.

Introduction: Low back pain affects about 70% of people in resource-rich countries at some point in their lives. Acute low back pain can be self-limiting; however, 1 year after an initial episode, as many as 33% of people still have moderate-intensity pain and 15% have severe pain. Acute low back pain has a high recurrence rate; 75% of those with a first episode have a recurrence. Read More

Cutis 2010 Feb;85(2):77-81

Department of Dermatology, University of California, Irvine, USA.

Notalgia paresthetica (NP) is a common refractory, sensory, neuropathic syndrome with the hallmark symptom of localized pruritus of the unilateral infrascapular back. It generally is a chronic noncurable condition with periodic remissions and exacerbations. While the dermatologic syndrome may be multifactorial in etiology, a possible association with underlying cervical spine disease should be evaluated for proper treatment. Read More

BMJ Clin Evid 2010 Oct 8;2010. Epub 2010 Oct 8.

Oregon Health & Science University, Portland, USA.

Introduction: Over 70% of people in developed countries develop low back pain (LBP) at some time. But recovery is not always favourable: 82% of non recent-onset patients still experience pain 1 year later. Many patients with chronic LBP who were initially told that their natural history was good spend months or years seeking relief. Read More

BMJ Clin Evid 2009 Mar 26;2009. Epub 2009 Mar 26.

Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK.

Introduction: Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30-50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc. Read More

J Man Manip Ther 2008 ;16(2):E42-52

Professor, Division of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.

We report a systematic analysis of group change scores of subjects with chronic neck pain not due to whiplash and without headache or arm pain, in randomized clinical trials of a single session of manual therapy. A comprehensive literature search of clinical trials of chronic neck pain treated with manual therapies up to December 2006 was conducted. Trials that scored above 60% on the PEDro Scale were included. Read More

BMJ Clin Evid 2008 Oct 3;2008. Epub 2008 Oct 3.

CBIHealth, Toronto, Canada.

Introduction: Low back pain (LBP) affects about 70% of people in resource-rich countries at some point. Acute low back pain is usually perceived as self-limiting; however, one year later, as many as 33% of people still have moderate-intensity pain and 15% have severe pain. It has a high recurrence rate; 75% of those with a first episode have a recurrence. Read More

BMJ Clin Evid 2008 Oct 1;2008. Epub 2008 Oct 1.

Department of Surgery, University of Toronto, Toronto, Canada.

Introduction: Over 70% of people in resource-rich countries develop low back pain (LBP) at some time. But recovery is not always favourable: 82% of non-recent-onset patients still experience pain one year later. Many chronic patients who were initially told that their natural history was good spend months or years seeking relief. Read More

Ann Intern Med 2007 Oct;147(7):492-504

Oregon Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon 97239, USA.

Background: Many nonpharmacologic therapies are available for treatment of low back pain.

Purpose: To assess benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser therapy, lumbar supports, shortwave diathermy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography), spinal manipulation, and yoga for acute or chronic low back pain (with or without leg pain).

Data Sources: English-language studies were identified through searches of MEDLINE (through November 2006) and the Cochrane Database of Systematic Reviews (2006, Issue 4). Read More

J Can Chiropr Assoc 2005 Sep;49(3):158-209

Objective: To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized.

Options: Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. Read More

J Manipulative Physiol Ther 2007 Mar-Apr;30(3):215-27

Canadian Memorial Chiropractic College, Toronto, ON, Canada.

Objective: This study provides a systematic analysis of group change scores in randomized clinical trials of chronic neck pain not due to whiplash and not including headache or arm pain treated with manual therapy.

Methods: A comprehensive literature search of clinical trials of chronic neck pain treated with manual therapies up to December 2005. Only clinical trials scoring above 11. Read More