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Manipulation and mobilisation in acute low back pain

Three Part Question

[In adult patients presenting with acute lower back pain] is [mobilisation or manipulation better than standard conservative care] at [reducing pain, increasing mobility and speeding a return to normal activities]

Clinical Scenario

A 32 year old factory worker presents to his GP with a 5 day history of acute back pain. He is previously fit and well and sustained his back injury when he was lifting a heavy weight. There are no red flags to indicate significant spinal pathology. Clinical examination reveals restriction of movement due to pain but no neurological signs. You diagnose a simple musculoskeletal strain and adverse mobilisation and analgesia. He tells you that his company has access to a chiropractic service and wonders if you think it is effective. You decide to find out.

Search Strategy

Medline 2000-March 2005 via OVID interface on Athens.
Cochrane database of systematic reviews Edition 1. 2005.
Cochrane controlled trials register Edition 1. 2005.
[ or exp Osteopathic Medicine/ or exp Osteopathic Medicine/ or osteopa$.mp. or exp Chiropractic/ or or exp Manipulation, Chiropractic/ or
exp Physical Therapy Techniques/ or or exp Manipulation, Orthopedic/ or manual physiotherap$.mp.] AND [back or exp Back Pain/ or exp Low Back Pain/ or lumbar or exp Back Pain/] AND [OVID therapy filter (sensitivity) limit to humans and english language and abstracts and yr=2000-2005

Search Outcome

Medline - 293 citations of which # were relevant to the clinical question
Cochrane database of systematic reviews- 59 citations of which one was directly relevant.
Cochrane controlled trials register - 162 citations. No new citations found.