title: Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis.
abstract: OBJECTIVE
  The purpose of this project was to review the literature for the use of spinal manipulation for low back pain (LBP).
  
  
  METHODS
  A search strategy modified from the Cochrane Collaboration review for LBP was conducted through the following databases: PubMed, Mantis, and the Cochrane Database. Invitations to submit relevant articles were extended to the profession via widely distributed professional news and association media. The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input.
  
  
  RESULTS
  A total of 887 source documents were obtained. Search results were sorted into related topic groups as follows: randomized controlled trials (RCTs) of LBP and manipulation; randomized trials of other interventions for LBP; guidelines; systematic reviews and meta-analyses; basic science; diagnostic-related articles, methodology; cognitive therapy and psychosocial issues; cohort and outcome studies; and others. Each group was subdivided by topic so that team members received approximately equal numbers of articles from each group, chosen randomly for distribution. The team elected to limit consideration in this first iteration to guidelines, systematic reviews, meta-analyses, RCTs, and coh ort studies. This yielded a total of 12 guidelines, 64 RCTs, 13 systematic reviews/meta-analyses, and 11 cohort studies.
  
  
  CONCLUSIONS
  As much or more evidence exists for the use of spinal manipulation to reduce symptoms and improve function in patients with chronic LBP as for use in acute and subacute LBP. Use of exercise in conjunction with manipulation is likely to speed and improve outcomes as well as minimize episodic recurrence. There was less evidence for the use of manipulation for patients with LBP and radiating leg pain, sciatica, or radiculopathy.
authors.affiliation: Center for Teaching and Learning, Palmer College of Chiropractic, Davenport, Iowa, USA. dana.lawrence@palmer.edu
authors.forename: Dana J
authors.initials: DJ
authors.lastname: Lawrence
authors.forename: William
authors.initials: W
authors.lastname: Meeker
authors.forename: Richard
authors.initials: R
authors.lastname: Branson
authors.forename: Gert
authors.initials: G
authors.lastname: Bronfort
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Cates
authors.forename: Mitch
authors.initials: M
authors.lastname: Haas
authors.forename: Michael
authors.initials: M
authors.lastname: Haneline
authors.forename: Marc
authors.initials: M
authors.lastname: Micozzi
authors.forename: William
authors.initials: W
authors.lastname: Updyke
authors.forename: Robert
authors.initials: R
authors.lastname: Mootz
authors.forename: John J
authors.initials: JJ
authors.lastname: Triano
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hawk
mesh_terms: D000208:Acute Disease / Q000628:therapy; D002908:Chronic Disease / Q000628:therapy; D004185:Disability Evaluation; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007866:Leg; D017116:Low Back Pain / Q000145:classification* / Q000628:therapy*; D026882:Manipulation, Chiropractic / Q000379:methods* / Q000706:statistics & numerical data; D010146:Pain / Q000145:classification*; D059408:Pain Management; D010147:Pain Measurement / Q000706:statistics & numerical data; D010808:Physical Examination / Q000379:methods; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'