Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies


OBJECTIVE: The objective of this selective EBM review is to determine whether or not “can spinal manipulation be used as an effective method to reduce pain for patients with a lumbar disc herniation compared to traditional methods?”

STUDY DESIGN: A systematic review of one randomized controlled trial, one randomized controlled pilot study, and one double-blind, randomized control trial published in 2010 and after. All studies were published in English.

DATA SOURCES: Data sources for this review were articles published in peer-reviewed journals using PubMed Database.

OUTCOME(S) MEASURED: The outcome measured was change in pain. This was accomplished by using a Numeric Analog Scale (NAS), Aberdeen Back Pain Scale, and a Visual Analogue Pain Scale (VAS).

RESULTS: McMorland et al. proved that spinal manipulation was effective in decreasing pain and should be considered for patients prior to resorting to surgery. This study was statistically significant (P=0.034). Lopez- Diaz et al. proved that spinal manipulation was effective in decreasing pain and was significantly more successful than traditional physiotherapy techniques (P = 0.004). Demirel et al. found that spinal manipulation can be used as an assistive agent with traditional physiotherapy methods but that there was no significant reduction in pain between groups. No statistically significance was noted in this study. (P =0.789).

CONCLUSION: While reduction of pain from baseline was noted in all three studies based on decrease in mean change from baseline, statistical significance was not noted in Demirel et al. Furthermore, each studies reccomendation on when to implement spinal manipulation varied. Thus, the results of this review are inconclusive. Further research with a larger sample size is warranted to determine the benefits of spinal manipulation