Spinal Manipulation vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis

Jay K Ruddock, Hannah M Sallis, Andy R Ness, Rachel E Perry

Research output: Contribution to journalArticle (Academic Journal)peer-review

31 Citations (Scopus)
405 Downloads (Pure)



The purpose of this systematic review was to identify and critically evaluate randomized controlled trials of spinal manipulation (SM) vs sham manipulation in the treatment of nonspecific low back pain.


Four electronic databases were searched from their inception to March 2015 to identify all relevant trials. Reference lists of retrieved articles were hand-searched. All data were extracted by 2 independent reviewers, and risk of bias was assessed using the Cochrane Back Review Group Risk of Bias tool.


Nine randomized controlled trials were included in the systematic review, and 4 were found to be eligible for inclusion in a meta-analysis. Participants in the SM group had improved symptoms compared with participants receiving sham treatment (standardized mean difference = − 0.36; 95% confidence interval, − 0.59 to − 0.12). The majority of studies were of low risk of bias; however, several of the studies were small, the practitioner could not be blinded, and some studies did not conduct intention-to-treat analysis and had a high level of dropouts.


There is some evidence that SM has specific treatment effects and is more effective at reducing nonspecific low back pain when compared with an effective sham intervention. However, given the small number of studies included in this analysis, we should be cautious of making strong inferences based on these results.

Original languageEnglish
Pages (from-to)165–183
Number of pages19
JournalJournal of Chiropractic Medicine
Issue number3
Early online date25 May 2016
Publication statusPublished - Sept 2016


  • Low back pain
  • Manipulation
  • Spinal
  • Placebo
  • Review of the literature


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