Spinal Manipulation is First Line of Care for Back Pain

When the American Pain Society and the American College of Physicians call on spinal manipulation to be the first line of care for back pain, those back pain specialists who offer spinal manipulation are ready (1). Those who offer specific spinal manipulation like Cox Technic that has evidence-based protocols and biomechanical and clinical outcomes behind it have the confidence to address back pain and neck pain with spinal manipulation.
Interestingly, back pain is treated by a number of professionals like pain physicians (2%), acupuncturists (7%), chiropractic physicians (40%) and primary care physicians (52%). Who feels the least likely to feel confident to manage such musculoskeletal pain and neuropathic pain? The primary care physicians. (2) Chiropractors are specially trained to examine, diagnose and treat back pain. (Between their ability to reduce back pain and their hands-on approach to healing, chiropractors have a special way that they are also able to talk with their patients about wellness and healthy lifestyle issues, too. That's a discussion for another time...) Now, back to back pain...
Even before surgery for back pain (baseball players return to play faster non-surgically than surgically treated (3) and surgical outcomes after 1 year for disc herniation and sciatica is 49% to 58% successful (4)  plus the University of Pittsburgh Medical Center requires chiropractic/spinal manipulation before back surgery referral (9) ), before epidural steroids for back pain (which are being called for a ban in Switzerland because there is no support for their use (5) ), before drugs for back pain (moderate to low quality efficacy for NSAID and other drugs sued for sciatica (6) ), before imaging for back pain (due to the risk of radiation exposure (7)...and cost in today's healthcare climate), a trial of spinal manipulation is reasonable. And patients with radiculopathy did significantly better with flexion distraction (Cox Technic) spinal manipulation than medical care. (8)
So if back pain or other spine or spine-related condition is the issue, shouldn't spinal manipulation be the top choice for its relief by the back pain specialist doctor and the back pain patient? Just a consideration...

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