J Manipulative Physiol Ther. 2001 Sep; 24(7): 449-56.

Rating specific chiropractic technique procedures for common low back conditions.

Gatterman MI, Cooperstein R, Lantz C, Perle SM, Schneider MJ.

Chiropractic Physicians and Consultants Group, Portland, OR, USA.

OBJECTIVE: To rate specific chiropractic technique procedures used in the treatment of common low back conditions. DESIGN AND METHODS: A panel of chiropractors rated specific chiropractic technique procedures for their effectiveness in the treatment of common low back conditions, based on the quality of supporting evidence after systematic literature reviews and expert clinical opinion. Statements related to the rating process and clinical practice were then developed through a facilitated nominal consensus process. RESULTS: For most low back conditions presented in this study, the three procedures rated most effective were high-velocity, low- amplitude (HVLA) with no drop table (side posture), distraction technique, and HVLA prone with drop table assist. The three rated least effective were upper cervical technique, non-thrust reflex/low force, and lower extremity adjusting. The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain. CONCLUSIONS: The ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions.