Low Back Pain: Should I Have Spinal Manipulation?

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You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Low Back Pain: Should I Have Spinal Manipulation?

Get the facts

Your options

  • Have spinal manipulation for your low back pain with or without other treatments.
  • Don't have spinal manipulation. Try things like heat or ice, medicine, physical therapy, exercise, massage, mobilization, acupuncture, changing the way you do your activities, or getting cognitive-behavioral therapy instead.

If your symptoms are very bad or are getting worse, or if you're getting new symptoms, be sure to tell your doctor.

Key points to remember

  • Spinal manipulation is done to ease pain and help the body function better. Like most low back pain treatments, it works for some people but not for others.
  • Spinal manipulation can work as well as other treatments for low back pain, whether the pain is new or has lasted a long time. But pain relief may only last for a short time.
  • Spinal manipulation may be more likely to help back pain than to help leg pain. But it may help both.
  • All treatments for low back pain have possible side effects. After spinal manipulation, some people feel tired or sore. Serious problems are very rare. Spinal manipulation is safe when performed by a trained health care provider.
  • Most people with low back pain can get better with good home treatment like using heat or ice, staying active, and doing certain exercises. Other people may feel better when they try things like medicine, physical therapy, massage, mobilization, acupuncture, changing the way they do their activities, or getting cognitive-behavioral therapy.
  • No matter what back pain treatment you choose, learn how to take care of your back. Stay active and do exercises that help your muscles better support your joints. Good self care will help your back stay strong and help you feel better.
FAQs

What is spinal manipulation?

Spinal manipulation, also called spinal adjustment, is a therapy that uses pressure on a joint of the spine. It is used to ease pain and help the body function better. Manipulation can be done with the hands or a special device. The careful, controlled force used on the joint can range from gentle to strong, and from slow to rapid. Sometimes other joints of the body are also worked on to help treat the spine.

Spinal manipulation can be used with other treatments. These may include heat or ice, medicines, physical therapy, exercise, massage, mobilization, acupuncture, changing the way you do your activities, or getting cognitive-behavioral therapy.

How well does spinal manipulation work for low back pain?

Spinal manipulation can work as well as other treatments for low back pain, whether the pain is new or has lasted a long time. But pain relief may only last for a short time. Like most low back pain treatments, spinal manipulation works for some people but not for others.

How do you choose someone to do spinal manipulation?

If you are looking for a health care provider who is trained to do spinal manipulation, ask friends about who they do and don't like, and why. Check the background and education of providers you're interested in. It may help to have a visit to make sure you are comfortable with a provider's practice style.

Health care providers who are commonly trained to do spinal manipulation include:

Make your family doctor aware of your other providers and the treatments you are getting.

Some medical insurance plans cover chiropractic care. If you have insurance, check to see if your plan covers this treatment.

What are the risks of spinal manipulation?

Spinal manipulation is safe when performed by a trained health care provider. Some people feel tired or sore after treatment.

A very rare but serious nerve problem, which can cause weakness or a bladder or bowel problem, may be related to spinal manipulation. But some experts question whether it is related.

Spinal manipulation is not recommended for people who have certain health problems like osteoporosis , bone fractures, or spondylolisthesis .

Some types of spinal manipulation may make certain back problems worse. That's because the force on the joint may involve strong, rapid movements. This level of force can cause problems for people who have sciatica or spinal stenosis .

What other treatments are there besides spinal manipulation?

There are many treatments you can try. You can do these whether or not you are doing spinal manipulation. These include:

  • Medicines. Acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs like ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve) may help your pain. Be safe with medicines. Read and follow all instructions on the label.
  • Physical therapy. This helps you learn stretching and strength exercises that may reduce pain and other symptoms. The goal of this treatment is to make your daily tasks and activities easier.
  • Massage. Massage can help relax muscles, increase blood flow, and ease pain in the soft tissues. You can do it yourself, or you can have a massage therapist do it.
  • Mobilization. Slow, measured movements are used to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint. It can also help with flexibility and alignment.
  • Acupuncture. It involves putting tiny needles into your skin at certain points on the body to promote healing and pain relief.
  • Cognitive-behavioral therapy. This treatment focuses on helping you change how you think about the pain and find ways to deal with it.

Home treatments

There are several things you can do at home to help reduce your pain. For example:

  • Heat or ice. Heat can reduce pain and stiffness. Ice can help reduce pain and swelling. You might want to switch back and forth between heat and cold until you find what helps you the most.
  • Exercise. Walking is one of the best things you can do for your back. You can try other activities too, like swimming. You can also do exercises that gently stretch and strengthen your stomach, back, hips, and leg muscles. The stronger those muscles are, the better they're able to protect your back.
  • Changing the way you do your activities. Try other ways of doing your activities that don't cause pain or make your symptoms worse. For example:
    • Bend forward carefully. When you must bend forward to empty the dishwasher, pick up clothes, make the bed, or do other chores, bend carefully in a way that doesn't cause pain.
    • When you lift, use your leg muscles and your stomach muscles to do most of the work. And keep whatever you're lifting as close to your body as you can.
    • Sit in a chair that is low enough that you can place both feet flat on the floor. If your chair or desk is too high, use a foot rest to raise your legs. And change positions often when you sit. Take brief standing breaks about every 10 minutes.
    • Take rest breaks. Don't do any one type of movement for too long without taking a break. And try to alternate chores so you're not doing the same movement (even with breaks) for a long time.
    • In bed, try lying on your side with a pillow between your knees. Or lie on your back on the floor with a pillow under your knees.
    • If you must stand in one position for a long time, put one foot on a low stool. Alternate feet.

Why might you consider spinal manipulation?

  • You want a treatment that involves hands-on contact.
  • You have tried other treatments—heat or ice, medicine, physical therapy, exercise, massage, mobilization, acupuncture, changing the way you do your activities, or getting cognitive-behavioral therapy—for a few weeks, and your back pain is not better.
  • You want a treatment that does not involve medicines.
  • You have had spinal manipulation before, and it has helped.

Compare your options

Compare

What is usually involved?

















What are the benefits?

















What are the risks and side effects?

















Have spinal manipulation Have spinal manipulation
  • You lie on a special table while the practitioner puts pressure on a joint of the spine. Manipulation can be done with the hands or a special device. The careful, controlled force used on the joint can range from gentle to strong, and from slow to rapid. Sometimes other joints of the body are also worked on to help treat the spine.
  • You may need one or more spinal manipulation treatments. How many you may need will depend on how well the treatment is working.
  • You may also use other treatments, such as heat or ice, medicines, physical therapy, exercise, massage, mobilization, acupuncture, changing the way you do your activities, or getting cognitive-behavioral therapy.
  • Spinal manipulation can work as well as other treatments for low back pain, whether the pain is new or has lasted a long time. But pain relief may only last for a short time.
  • Some people feel tired or sore after spinal manipulation.
  • Although it is very rare, spinal manipulation may result in a serious nerve problem that can cause weakness or affect the bladder or bowel.
  • Spinal manipulation may not relieve your back pain.
Use other treatment Use other treatment
  • You try things like using heat or ice, medicine, physical therapy, exercise, massage, mobilization, acupuncture, or getting cognitive-behavioral therapy instead.
  • You find a comfortable position when you rest and other ways to do your activities that don't cause pain or make your symptoms worse.
  • Depending on which treatment you try, you may need one or more treatments. How many you may need will depend on how well the treatment is working.
  • Most people with low back pain can get better with good home treatment like using heat or ice, staying active, and doing certain exercises.
  • Other people may feel better when they try things like medicine, physical therapy, massage, mobilization, acupuncture, changing the way they do their activities, or getting cognitive-behavioral therapy.
  • Other treatments may not relieve your back pain.
  • If you use medicine, you may have side effects from them, such as nausea or an upset stomach.

Personal stories about spinal manipulation for low back pain

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I grew up in a family that swears by spinal manipulation. When I moved out on my own in another city, I went to the chiropractor down the street from me when I hurt my back. I didn't feel comfortable. This guy had a totally different approach than my old chiropractor. After asking various friends, I found another chiropractor I felt more comfortable with.

Tara, age 24

I've put up with bouts of this back pain over the years, but this time I couldn't walk right. A friend of mine suggested I see his osteopathic doctor to have my spine worked on. I didn't know much about spinal manipulation, but I thought I'd give it a try. And you know, after three visits, my pain got a lot better.

Joe, age 40

I'm pretty careful about who I choose for my medical care. So I did some research before going to see someone about treating my back pain. I'd heard about some people who actually felt worse after spinal manipulation. I'd also heard from friends that manipulation helped them a lot. So I talked to my doctor and got the name of a chiropractor. I talked to her on the phone ahead of time about how she practices. She sounded great. After I made sure that she was covered by my health insurance, I took the first appointment that was available. A few appointments and daily exercises at home have brought me such relief!

Sandra, age 37

I went to a physical therapist who has helped me with my back with spinal manipulation before. But this time my symptoms were different, and he was concerned. I had pain and weakness in my leg that was getting worse. My physical therapist worked with my family doctor, and I was referred to a surgeon.

Dave, age 55

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose spinal manipulation

Reasons not to choose spinal manipulation

I am comfortable with treatment that involves hands-on contact.

I don't like the idea of treatments that involve physical contact.

More important
Equally important
More important

I want to avoid using medicine for my pain.

Medicine or another treatment will help relieve my pain.

More important
Equally important
More important

My schedule is flexible, so I can take time out of my day to get treatment.

I don't have time in my day to get treatment.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Trying spinal manipulation

NOT trying spinal manipulation

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Do most people with low back pain get better without spinal manipulation?
2, Is spinal manipulation a back pain treatment that works for everyone?
3, Can spinal manipulation help relieve your back pain over the long term?

Decide what's next

1, Do you understand the options available to you?
2, Are you clear about which benefits and side effects matter most to you?
3, Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics

References
Other Works Consulted
  • Bronfort G, et al. (2014). Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain. Annals of Internal Medicine, 161(6): 381–391. DOI: 10.7326/M14-0006. Accessed June 9, 2015.
  • Rubinstein SM, et al. (2011). Spinal manipulative therapy for chronic low back pain. Spine, 36(13): E825–E846. DOI: 10.1097/BRS.0b013e3182197fe1. Accessed June 9, 2015.
  • Rubinstein SM, et al. (2013). Spinal manipulative therapy for acute low back pain. Spine, 38(3): E158–E177. DOI: 10.1097/BRS.0b013e31827dd89d. Accessed June 9, 2015.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Low Back Pain: Should I Have Spinal Manipulation?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have spinal manipulation for your low back pain with or without other treatments.
  • Don't have spinal manipulation. Try things like heat or ice, medicine, physical therapy, exercise, massage, mobilization, acupuncture, changing the way you do your activities, or getting cognitive-behavioral therapy instead.

If your symptoms are very bad or are getting worse, or if you're getting new symptoms, be sure to tell your doctor.

Key points to remember

  • Spinal manipulation is done to ease pain and help the body function better. Like most low back pain treatments, it works for some people but not for others.
  • Spinal manipulation can work as well as other treatments for low back pain, whether the pain is new or has lasted a long time. But pain relief may only last for a short time.
  • Spinal manipulation may be more likely to help back pain than to help leg pain. But it may help both.
  • All treatments for low back pain have possible side effects. After spinal manipulation, some people feel tired or sore. Serious problems are very rare. Spinal manipulation is safe when performed by a trained health care provider.
  • Most people with low back pain can get better with good home treatment like using heat or ice, staying active, and doing certain exercises. Other people may feel better when they try things like medicine, physical therapy, massage, mobilization, acupuncture, changing the way they do their activities, or getting cognitive-behavioral therapy.
  • No matter what back pain treatment you choose, learn how to take care of your back. Stay active and do exercises that help your muscles better support your joints. Good self care will help your back stay strong and help you feel better.
FAQs

What is spinal manipulation?

Spinal manipulation, also called spinal adjustment, is a therapy that uses pressure on a joint of the spine. It is used to ease pain and help the body function better. Manipulation can be done with the hands or a special device. The careful, controlled force used on the joint can range from gentle to strong, and from slow to rapid. Sometimes other joints of the body are also worked on to help treat the spine.

Spinal manipulation can be used with other treatments. These may include heat or ice, medicines, physical therapy, exercise, massage, mobilization, acupuncture, changing the way you do your activities, or getting cognitive-behavioral therapy.

How well does spinal manipulation work for low back pain?

Spinal manipulation can work as well as other treatments for low back pain, whether the pain is new or has lasted a long time. But pain relief may only last for a short time. Like most low back pain treatments, spinal manipulation works for some people but not for others.

How do you choose someone to do spinal manipulation?

If you are looking for a health care provider who is trained to do spinal manipulation, ask friends about who they do and don't like, and why. Check the background and education of providers you're interested in. It may help to have a visit to make sure you are comfortable with a provider's practice style.

Health care providers who are commonly trained to do spinal manipulation include:

Make your family doctor aware of your other providers and the treatments you are getting.

Some medical insurance plans cover chiropractic care. If you have insurance, check to see if your plan covers this treatment.

What are the risks of spinal manipulation?

Spinal manipulation is safe when performed by a trained health care provider. Some people feel tired or sore after treatment.

A very rare but serious nerve problem, which can cause weakness or a bladder or bowel problem, may be related to spinal manipulation. But some experts question whether it is related.

Spinal manipulation is not recommended for people who have certain health problems like osteoporosis , bone fractures, or spondylolisthesis .

Some types of spinal manipulation may make certain back problems worse. That's because the force on the joint may involve strong, rapid movements. This level of force can cause problems for people who have sciatica or spinal stenosis .

What other treatments are there besides spinal manipulation?

There are many treatments you can try. You can do these whether or not you are doing spinal manipulation. These include:

  • Medicines. Acetaminophen (such as Tylenol) and nonsteroidal anti-inflammatory drugs like ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve) may help your pain. Be safe with medicines. Read and follow all instructions on the label.
  • Physical therapy. This helps you learn stretching and strength exercises that may reduce pain and other symptoms. The goal of this treatment is to make your daily tasks and activities easier.
  • Massage. Massage can help relax muscles, increase blood flow, and ease pain in the soft tissues. You can do it yourself, or you can have a massage therapist do it.
  • Mobilization. Slow, measured movements are used to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint. It can also help with flexibility and alignment.
  • Acupuncture. It involves putting tiny needles into your skin at certain points on the body to promote healing and pain relief.
  • Cognitive-behavioral therapy. This treatment focuses on helping you change how you think about the pain and find ways to deal with it.

Home treatments

There are several things you can do at home to help reduce your pain. For example:

  • Heat or ice. Heat can reduce pain and stiffness. Ice can help reduce pain and swelling. You might want to switch back and forth between heat and cold until you find what helps you the most.
  • Exercise. Walking is one of the best things you can do for your back. You can try other activities too, like swimming. You can also do exercises that gently stretch and strengthen your stomach, back, hips, and leg muscles. The stronger those muscles are, the better they're able to protect your back.
  • Changing the way you do your activities. Try other ways of doing your activities that don't cause pain or make your symptoms worse. For example:
    • Bend forward carefully. When you must bend forward to empty the dishwasher, pick up clothes, make the bed, or do other chores, bend carefully in a way that doesn't cause pain.
    • When you lift, use your leg muscles and your stomach muscles to do most of the work. And keep whatever you're lifting as close to your body as you can.
    • Sit in a chair that is low enough that you can place both feet flat on the floor. If your chair or desk is too high, use a foot rest to raise your legs. And change positions often when you sit. Take brief standing breaks about every 10 minutes.
    • Take rest breaks. Don't do any one type of movement for too long without taking a break. And try to alternate chores so you're not doing the same movement (even with breaks) for a long time.
    • In bed, try lying on your side with a pillow between your knees. Or lie on your back on the floor with a pillow under your knees.
    • If you must stand in one position for a long time, put one foot on a low stool. Alternate feet.

Why might you consider spinal manipulation?

  • You want a treatment that involves hands-on contact.
  • You have tried other treatments—heat or ice, medicine, physical therapy, exercise, massage, mobilization, acupuncture, changing the way you do your activities, or getting cognitive-behavioral therapy—for a few weeks, and your back pain is not better.
  • You want a treatment that does not involve medicines.
  • You have had spinal manipulation before, and it has helped.

2. Compare your options

  Have spinal manipulation Use other treatment
What is usually involved?
  • You lie on a special table while the practitioner puts pressure on a joint of the spine. Manipulation can be done with the hands or a special device. The careful, controlled force used on the joint can range from gentle to strong, and from slow to rapid. Sometimes other joints of the body are also worked on to help treat the spine.
  • You may need one or more spinal manipulation treatments. How many you may need will depend on how well the treatment is working.
  • You may also use other treatments, such as heat or ice, medicines, physical therapy, exercise, massage, mobilization, acupuncture, changing the way you do your activities, or getting cognitive-behavioral therapy.
  • You try things like using heat or ice, medicine, physical therapy, exercise, massage, mobilization, acupuncture, or getting cognitive-behavioral therapy instead.
  • You find a comfortable position when you rest and other ways to do your activities that don't cause pain or make your symptoms worse.
  • Depending on which treatment you try, you may need one or more treatments. How many you may need will depend on how well the treatment is working.
What are the benefits?
  • Spinal manipulation can work as well as other treatments for low back pain, whether the pain is new or has lasted a long time. But pain relief may only last for a short time.
  • Most people with low back pain can get better with good home treatment like using heat or ice, staying active, and doing certain exercises.
  • Other people may feel better when they try things like medicine, physical therapy, massage, mobilization, acupuncture, changing the way they do their activities, or getting cognitive-behavioral therapy.
What are the risks and side effects?
  • Some people feel tired or sore after spinal manipulation.
  • Although it is very rare, spinal manipulation may result in a serious nerve problem that can cause weakness or affect the bladder or bowel.
  • Spinal manipulation may not relieve your back pain.
  • Other treatments may not relieve your back pain.
  • If you use medicine, you may have side effects from them, such as nausea or an upset stomach.

Personal stories

Personal stories about spinal manipulation for low back pain

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I grew up in a family that swears by spinal manipulation. When I moved out on my own in another city, I went to the chiropractor down the street from me when I hurt my back. I didn't feel comfortable. This guy had a totally different approach than my old chiropractor. After asking various friends, I found another chiropractor I felt more comfortable with."

— Tara, age 24

"I've put up with bouts of this back pain over the years, but this time I couldn't walk right. A friend of mine suggested I see his osteopathic doctor to have my spine worked on. I didn't know much about spinal manipulation, but I thought I'd give it a try. And you know, after three visits, my pain got a lot better."

— Joe, age 40

"My back has been bothering me a lot. I thought about having spinal manipulation, but I'm not comfortable with the idea of someone pressing on my spine. Instead, I've decided to try massage and changing the way I do certain activities. So far these things have helped. And I'm now able to walk more and do some exercises to strengthen my back."

— Yolanda, age 61

"I'm pretty careful about who I choose for my medical care. So I did some research before going to see someone about treating my back pain. I'd heard about some people who actually felt worse after spinal manipulation. I'd also heard from friends that manipulation helped them a lot. So I talked to my doctor and got the name of a chiropractor. I talked to her on the phone ahead of time about how she practices. She sounded great. After I made sure that she was covered by my health insurance, I took the first appointment that was available. A few appointments and daily exercises at home have brought me such relief!"

— Sandra, age 37

"I went to a physical therapist who has helped me with my back with spinal manipulation before. But this time my symptoms were different, and he was concerned. I had pain and weakness in my leg that was getting worse. My physical therapist worked with my family doctor, and I was referred to a surgeon."

— Dave, age 55

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose spinal manipulation

Reasons not to choose spinal manipulation

I am comfortable with treatment that involves hands-on contact.

I don't like the idea of treatments that involve physical contact.

             
More important
Equally important
More important

I want to avoid using medicine for my pain.

Medicine or another treatment will help relieve my pain.

             
More important
Equally important
More important

My schedule is flexible, so I can take time out of my day to get treatment.

I don't have time in my day to get treatment.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Trying spinal manipulation

NOT trying spinal manipulation

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Do most people with low back pain get better without spinal manipulation?

  • Yes
  • No
  • I'm not sure
That's right. Most people with low back pain can get better with good home treatment like using heat or ice, staying active, and doing certain exercises. Other people may feel better when they try things like medicine, physical therapy, massage, mobilization, acupuncture, changing the way they do their activities, or getting cognitive-behavioral therapy.

2. Is spinal manipulation a back pain treatment that works for everyone?

  • Yes
  • No
  • I'm not sure
Correct. As with all treatments for back pain, this treatment works for some people but not for others.

3. Can spinal manipulation help relieve your back pain over the long term?

  • Yes
  • No
  • I'm not sure
That's correct. Spinal manipulation can work as well as other treatments for low back pain, whether the pain is new or has lasted a long time. But pain relief may only last for a short time.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics

References
Other Works Consulted
  • Bronfort G, et al. (2014). Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain. Annals of Internal Medicine, 161(6): 381–391. DOI: 10.7326/M14-0006. Accessed June 9, 2015.
  • Rubinstein SM, et al. (2011). Spinal manipulative therapy for chronic low back pain. Spine, 36(13): E825–E846. DOI: 10.1097/BRS.0b013e3182197fe1. Accessed June 9, 2015.
  • Rubinstein SM, et al. (2013). Spinal manipulative therapy for acute low back pain. Spine, 38(3): E158–E177. DOI: 10.1097/BRS.0b013e31827dd89d. Accessed June 9, 2015.

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