Course Details

What have we learned from the systematic review on spinal manipulative therapy published in the British Medical Journal?

We all know that low back pain is a common problem and costly burden to society. There are many promising treatments for chronic low back pain. The most commonly advocated treatments in national guidelines are exercise and cognitive behavioural therapy. But what about spinal manipulative therapy?

In order to best summarize the evidence, it is important to approach this systematically. As clinicians we are quite happy to cite those studies which demonstrate that SMT is an effective therapy, but tend to ignore or even find fault with those studies which cast doubt on its effectiveness, or suggest that other therapies might work better. This systematic review summarises ALL the available studies on SMT for chronic low back pain and thus, represent more accurately how SMT works in clinical practice. In this presentation, we spend the majority of the time presenting the lessons learned from this summary of the evidence. This review might not change the way you practice, but it can facilitate conversations with policymakers and other healthcare professionals where SMT is currently brought into question.

  • 1

    Spinal Manipulative Therapy for Low Back Pain

    • Spinal Manipulative Therapy for Low Back Pain Module

    • Spinal Manipulative Therapy for Low Back Pain Notes

    • Spinal Manipulative Therapy for Low Back Pain - BMJ Article

    • Assessment for Spinal Manipulative Therapy for Low Back Pain Module

Course Learning Outcomes

Spinal Manipulative Therapy (SMT) for Low Back Pain

1.) Primary Objective:

Learn what is known about the effect of SMT for chronic low back pain, and where knowledge (or evidence) is lacking.

The student will also be able to answer the following questions:

a.) How does SMT work for the various comparison therapies (i.e. recommended and non-recommended therapies, and sham SMT)?

b.) For which outcomes does SMT work best?

c.) Is SMT a safe treatment for chronic low back pain?

d.) Does it matter what type of professional delivers SMT or type of SMT (i.e. manipulation or mobilisation)?

e.) Is SMT cost-effective for chronic low back pain?

f.) Who is likely to benefit from SMT?

g.) How does it work for those with comorbidities?

2.) Seconday Objectives:

i) Understand the difference between a systematic review and meta-analysis

ii) Learn what criteria are most important when evaluating methodological quality.

CPD Hours/Points = 2


Chiropractor, Epidemiologist

Sidney Rubinstein

Sidney Rubinstein is an associate professor at the Vrije Universiteit Amsterdam and adjunct research professor at Southern California University of Health Sciences (SCUHS). He is also a registered epidemiologist in the Netherlands. He has more than 60 publications in international peer-reviewed journals, including three systematic reviews in the Cochrane Library. His research focuses on the effectiveness and cost-effectiveness of interventions for musculoskeletal disorders. Sidney’s broader goals are to lessen the burden of neck and low-back pain to society by providing high-quality scientific evidence. One of my passions lies with systematic reviews and meta-analysis as these types of overviews represent a crucial link in the practice of evidence-based healthcare. I am actively involved in conducting and supervising reviews, including a position on the Associate Editorial Board of the Cochrane Back and Neck Review Group.