The Source reference desk
Evidence you
can follow.
Go from a question to a guide.
From a guide to the original research.
For curious patients and fellow practitioners: a selection of the publications behind what we write. We include the studies that call a treatment into question as well as the ones that support it.
Find a publication70 publications
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Research, with context.
Selected published sources behind what we've written, each with what it found and what it can't tell us. We give you both halves because no paper can diagnose you or predict how your own care will go.
Efficacy of extracorporeal shock wave therapy combined with conventional physical therapy for chronic low back pain: a systematic review and network meta-analysis of randomized controlled trials
Randomized trials of adults with chronic low-back pain, comparing shock wave therapy, conventional physical therapy, the two combined, and sham; 14 reported pain and 8 reported function.
What it foundThe combination of shock wave therapy and physical therapy ranked first for pain and function and did better than physical therapy alone. Shock wave therapy alone reduced pain more than sham but showed no significant effect on function.
What it can't tell usThe authors call for more high-quality trials before the finding is settled. Devices and doses varied across the trials; the result doesn't describe StemWave or any single device.
Publication details & citation
Qiao et al. Efficacy of extracorporeal shock wave therapy combined with conventional physical therapy for chronic low back pain: a systematic review and network meta-analysis of randomized controlled trials. Frontiers in Physiology. 2026. DOI: 10.3389/fphys.2026.1807929.
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Comparison of the effectiveness of high-intensity laser therapy versus low-level laser therapy in musculoskeletal disorders: a systematic review and network meta-analysis
22 randomized trials with 1,353 people with muscle and joint disorders, comparing high-intensity laser with low-level laser, placebo laser or other treatments.
What it foundHigh-intensity laser reduced pain a little more than low-level laser in some comparisons, especially alongside exercise or other physical therapy.
What it can't tell usThe differences were generally modest and often smaller than the change considered clinically important, and the certainty of the evidence was mostly very low. The authors advise caution and placing laser within a broader rehabilitation plan.
Publication details & citation
de la Barra Ortiz et al. Comparison of the effectiveness of high-intensity laser therapy versus low-level laser therapy in musculoskeletal disorders: a systematic review and network meta-analysis. Lasers in Medical Science. 2026. DOI: 10.1007/s10103-026-04812-9.
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Effect of Local Laser Therapy on Plantar Fasciitis: A Meta-Analysis
13 randomized trials, 784 participants with plantar fasciitis, comparing laser therapy with placebo or other physical treatments.
What it foundLaser therapy may reduce heel tenderness. It showed no significant difference in overall pain, function or the thickness of the plantar fascia.
What it can't tell usThe trials mixed low-level and high-intensity lasers, and the pain and function results were highly inconsistent between trials. The authors say laser should be considered an add-on, not a primary treatment; the result doesn't describe any one device.
Publication details & citation
Ortiz-Romero et al. Effect of Local Laser Therapy on Plantar Fasciitis: A Meta-Analysis. Journal of Clinical Medicine. 2026. DOI: 10.3390/jcm15031307.
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Frequency and severity of adverse events associated with dry needling: a systematic review and meta-analysis
59 studies: case reports and series, surveys of 2,380 professionals, and trials and observational studies covering 1,947 patients.
What it foundMinor adverse events were common, reported in 0% to 48% of treatments depending on the study. Major adverse events were uncommon per treatment (0% to 0.43%) but were reported by a meaningful share of clinicians over a whole career.
What it can't tell usWhat counted as an event, and how it was reported, differed widely between studies. The rates describe the literature as a whole, not any one clinician, technique or body region.
Publication details & citation
Rabanal-Rodríguez et al. Frequency and severity of adverse events associated with dry needling: a systematic review and meta-analysis. Physical Therapy. 2026. DOI: 10.1093/ptj/pzag050.
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Effects of dry needling on functioning and pain relief in patients with chronic nonspecific neck pain: a systematic review and meta-analysis of randomized controlled trials
Five randomized trials of adults with chronic nonspecific neck pain, comparing dry needling, alone or added to physiotherapy, with sham, physical therapy or nothing.
What it foundDry needling reduced pain more than the comparison groups, but was not significantly better for function on the Neck Disability Index.
What it can't tell usFive trials only, and the authors call for further high-quality studies. It doesn't show dry needling is better than manual or physical therapy for function.
Publication details & citation
de Sire et al. Effects of dry needling on functioning and pain relief in patients with chronic nonspecific neck pain: a systematic review and meta-analysis of randomized controlled trials. Disability and Rehabilitation. 2026. DOI: 10.1080/09638288.2025.2529423.
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Extracorporeal shock wave therapy shows comparative results with other modalities for the management of plantar fasciitis: A systematic review and meta-analysis
15 randomized trials, 1,123 patients with plantar fasciitis, comparing shock wave therapy with placebo and six other conservative treatments.
What it foundShock wave therapy did better than placebo for pain and better than corticosteroid injection for function. Platelet-rich plasma injection did better than shock wave therapy for both, and custom orthotics improved function more than shock wave therapy; other comparisons showed no significant difference.
What it can't tell usTrials published after 2013 only, with varied protocols and devices. The pooled result doesn't describe StemWave or any single device, and can't tell us which device or dose produced it.
Publication details & citation
Tung et al. Extracorporeal shock wave therapy shows comparative results with other modalities for the management of plantar fasciitis: A systematic review and meta-analysis. Foot and Ankle Surgery. 2025. DOI: 10.1016/j.fas.2024.11.005.
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Efficacy of manipulation and therapeutic exercise applied to the neck region of patients with temporomandibular disorders: A systematic review and meta-analysis
14 randomized trials with 825 patients whose TMD came from the chewing muscles.
What it foundManipulation and exercise aimed at the neck lowered jaw and face pain ratings. Manipulation alone made little difference to how wide people could open their mouths; manipulation combined with neck exercises improved it.
What it can't tell usThe authors note that many manipulation and exercise approaches exist, with varying effects, and called for larger, better-designed trials. It covers muscle-related TMD only, not problems inside the joint.
Publication details & citation
Qu et al. Efficacy of manipulation and therapeutic exercise applied to the neck region of patients with temporomandibular disorders: A systematic review and meta-analysis. Journal of Stomatology, Oral and Maxillofacial Surgery. 2025. DOI: 10.1016/j.jormas.2025.102530.
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Lumbar Tractions in Radicular Pain Caused by Herniated Disc: Randomised, Open-Label, Superiority, and Controlled Trial on 424 Participants
424 patients at a hospital rheumatology unit with leg pain from a herniated disc that had not settled with outpatient treatment; all received medical treatment including at least two epidural injections, and half also received lumbar traction.
What it foundAt one month, 62% of the traction group and 51% of the medical-treatment group had at least a 25% improvement in leg pain (388 of the 424 were analysed).
What it can't tell usNobody was blinded, the main result was measured at one month, and the patients were hospital referrals already having injections, so it doesn't show what traction does on its own or for milder leg pain.
Publication details & citation
Bernhard et al. Lumbar Tractions in Radicular Pain Caused by Herniated Disc: Randomised, Open-Label, Superiority, and Controlled Trial on 424 Participants. Journal of Clinical Medicine. 2025. DOI: 10.3390/jcm14155192.
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Decision aids for people facing health treatment or screening decisions
209 studies of decision aids across a range of treatment and screening choices.
What it foundDecision aids improved knowledge and understanding of risks and helped people make choices that reflected their informed values.
What it can't tell usMost of the decisions studied had nothing to do with chiropractic care. It supports laying out the options and trade-offs plainly. It doesn't rank clinics, check credentials or show that any particular treatment works.
Publication details & citation
Stacey et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews. 2024. DOI: 10.1002/14651858.CD001431.pub6.
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- Between the shoulder blades
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Effects of high-intensity laser therapy on subacromial impingement syndrome: a systematic review and meta-analysis
6 trials, five of them randomized, with 284 people with shoulder impingement, comparing high-intensity laser with conventional therapy.
What it foundHigh-intensity laser did better than conventional therapy for pain and for shoulder and arm function, right after treatment and three months later.
What it can't tell usIt made no difference to shoulder flexion or outward rotation, and six trials is a small base. It doesn't describe any one device or dose, the Horizon included.
Publication details & citation
Hao et al. Effects of high-intensity laser therapy on subacromial impingement syndrome: a systematic review and meta-analysis. Lasers in Medical Science. 2024. DOI: 10.1007/s10103-024-04190-0.
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Quality appraisal of systematic reviews on high-intensity laser therapy for musculoskeletal pain management: an umbrella review
20 systematic reviews of high-intensity laser for muscle and joint pain, including the knee, shoulder, neck, low back and plantar fascia.
What it foundThe reviews reported pain relief across several conditions, with the largest effects in reviews of spinal disorders, frozen shoulder and neck pain.
What it can't tell usIt rated the reviews' own methods generally low to critically low in quality, with weak handling of publication bias and funding disclosure, so the pooled results are less certain than they look.
Publication details & citation
de la Barra Ortiz et al. Quality appraisal of systematic reviews on high-intensity laser therapy for musculoskeletal pain management: an umbrella review. Lasers in Medical Science. 2024. DOI: 10.1007/s10103-024-04241-6.
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The effects of photobiomodulation and transcutaneous electrical nerve stimulation on chronic neck pain: A double-blind, randomized, sham-controlled trial
144 people with chronic neck pain, assigned photobiomodulation, electrical stimulation, both, or sham treatment for ten sessions over two weeks.
What it foundThe groups did not differ in the primary outcome of pain at rest. Some secondary outcomes favored the combined treatment.
What it can't tell usThe secondary findings came from light and electrical stimulation combined, so they can't tell us what light therapy alone does. The treatment period was also short.
Publication details & citation
Rampazo et al. The effects of photobiomodulation and transcutaneous electrical nerve stimulation on chronic neck pain: A double-blind, randomized, sham-controlled trial. Brazilian Journal of Physical Therapy. 2024. DOI: 10.1016/j.bjpt.2024.101124.
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Pneumothorax as a complication of dry needling technique
Four patients treated for pneumothorax after dry needling of the shoulder or neck region at one Belgian university hospital over 15 months.
What it foundThe authors conclude that pneumothorax after dry needling is not extremely rare, and that consent should name it as a considerable risk for needling in the neck, shoulder or chest region.
What it can't tell usA case series establishes that a harm can happen, not how often. Frequency estimates come from the systematic review of adverse events, not from this series.
Publication details & citation
Bontinck et al. Pneumothorax as a complication of dry needling technique. ERJ Open Research. 2024. DOI: 10.1183/23120541.00156-2024.
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Spinal manipulation and mobilisation in paediatrics – an international evidence-based position statement for physiotherapists
Evidence and recommendations concerning infants, children and adolescents, developed through evidence reviews and professional consensus.
What it foundThe statement recommends against manipulation or mobilization in infants, cervical or lumbar manipulation in children, and these interventions for non-musculoskeletal childhood conditions.
What it can't tell usIt's a position statement written for physiotherapists, not a treatment trial. High-certainty evidence was missing, and the harms reported ranged in severity, with no reliable figure for how often they happen. Research on adult back pain can't show that a treatment is safe or helpful for a child.
Publication details & citation
Gross et al. Spinal manipulation and mobilisation in paediatrics – an international evidence-based position statement for physiotherapists. Journal of Manual & Manipulative Therapy. 2024. DOI: 10.1080/10669817.2024.2332026.
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High-intensity laser therapy in low back pain management: a systematic review with meta-analysis
Randomized trials in adults with low back pain, published before January 2023, comparing high-intensity laser with control treatments.
What it foundPain after treatment was lower with high-intensity laser than in the control groups, and two disability scores were lower too.
What it can't tell usThe disability results rested on three trials, the pain results varied a fair amount between trials, and the abstract doesn't weigh the differences against the change patients consider meaningful. It doesn't describe any one device or dose, the Horizon included.
Publication details & citation
Abdildin et al. High-intensity laser therapy in low back pain management: a systematic review with meta-analysis. Lasers in Medical Science. 2023. DOI: 10.1007/s10103-023-03827-w.
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High-intensity laser therapy on pain relief in symptomatic knee osteoarthritis: A systematic review and meta-analysis
9 studies of high-intensity laser for knee osteoarthritis pain, compared with sham laser, other lasers, conventional physiotherapy or exercise.
What it foundAll nine studies reported less knee pain with high-intensity laser. The authors called it promising, especially combined with exercise.
What it can't tell usThe comparison against a sham laser rested on two studies with 136 people over a short course of treatment. It doesn't describe any one device or dose, the Horizon included.
Publication details & citation
Cai et al. High-intensity laser therapy on pain relief in symptomatic knee osteoarthritis: A systematic review and meta-analysis. Journal of Back and Musculoskeletal Rehabilitation. 2023. DOI: 10.3233/BMR-220228.
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The effectiveness of high-intensity laser therapy in individuals with neck pain: a systematic review and meta-analysis
8 randomized trials of high-intensity laser in people with neck pain.
What it foundCompared with placebo, high-intensity laser may improve pain and some neck movements, on moderate-quality evidence. The authors suggest it as an add-on treatment.
What it can't tell usLow-quality evidence found no clear benefit for everyday function, and there was little information on quality of life. It doesn't describe any one device or dose, the Horizon included.
Publication details & citation
Xie et al. The effectiveness of high-intensity laser therapy in individuals with neck pain: a systematic review and meta-analysis. Physiotherapy. 2023. DOI: 10.1016/j.physio.2023.07.003.
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Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis
26 studies comparing sagittal head and neck posture between people with neck pain and pain-free people.
What it foundThe craniovertebral angle was about 3 degrees smaller in people with neck pain (pooled difference -2.93 degrees) and correlated negatively with pain and disability scores. Two other posture measures showed no significant difference.
What it can't tell usA 3-degree pooled difference is of the same order as the age and sex differences the same review found (about 2.4 and 2.6 degrees), and the studies were observational, so direction of cause is unknown.
Publication details & citation
Rani et al. Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis. Indian Journal of Orthopaedics. 2023. DOI: 10.1007/s43465-023-00820-x.
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Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials
153 trials involving 8,713 participants contributed to the network analyses of chronic TMD pain.
What it foundAmong comparisons with more certain evidence, approaches supporting movement and coping improved pain. These included selected supervised exercises, mobilization and psychological approaches.
What it can't tell usCertainty varied by treatment and outcome, and evidence about adverse events was low or very low certainty. It isn't evidence for treating every headache or an acute jaw injury.
Publication details & citation
Yao et al. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ. 2023. DOI: 10.1136/bmj-2023-076226.
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The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomized trial
Follow-up of 234 adults randomized to injection or night splinting for mild-to-moderate carpal tunnel syndrome.
What it foundSymptom, function and pain scores did not significantly differ between the groups at 12 or 24 months.
What it can't tell usAbout 71% to 73% responded at 24 months. Severe carpal tunnel syndrome was outside this comparison, and the trial didn't test chiropractic care.
Publication details & citation
Burton et al. The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomized trial. Rheumatology. 2023. DOI: 10.1093/rheumatology/keac219.
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Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial
60 people with lumbar radiculopathy, all given routine physical therapy, half also given non-surgical decompression on a computerized table, 12 sessions over four weeks.
What it foundThe decompression group improved more in pain, disability, back range of motion, back muscle endurance and two quality-of-life measures at four weeks.
What it can't tell usIt was one small trial with no sham treatment, and its outcomes were reported at the end of the four weeks of treatment, so it can't say how long any difference lasts.
Publication details & citation
Amjad et al. Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05196-x.
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Appraisal of the New Posture Analyzing and Virtual Reconstruction Device (PAViR) for Assessing Sagittal Posture Parameters: A Prospective Observational Study
70 rehabilitation patients at one Korean hospital, each measured on the same day by full-body EOS radiography and by PAViR version 2.11 (Moti Physio, MG Solutions) with an Orbbec depth camera.
What it foundForward head, T1 tilt and pelvic tilt correlated moderately with the radiographs (r 0.62 to 0.80); knee flexion and lumbar lordosis correlated fairly (r about 0.5). Median values differed significantly on four of the seven measures. The authors call the validation acceptable and the accuracy in need of improvement.
What it can't tell usOne clinic, one examiner reading the radiographs, patients in tight clothing with markers attached, and a test position the authors note the device does not normally use. The tested version has since been superseded, and no later validation is cited.
Publication details & citation
Jang et al. Appraisal of the New Posture Analyzing and Virtual Reconstruction Device (PAViR) for Assessing Sagittal Posture Parameters: A Prospective Observational Study. International Journal of Environmental Research and Public Health. 2022. DOI: 10.3390/ijerph191711109.
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Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision
People with lateral ankle sprains or chronic ankle instability.
What it foundThe guideline supports rehabilitation that includes mobility, balance and neuromuscular exercise. Manual therapy can accompany exercise.
What it can't tell usThe plan depends on the injury and the stage of recovery. The recommendations don't apply to fractures, and they don't show that a brace alone resolves chronic instability.
Publication details & citation
Martin et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision. Journal of Orthopaedic & Sports Physical Therapy. 2021. DOI: 10.2519/jospt.2021.0302.
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2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis
People with rheumatoid arthritis, including recommendations for disease-modifying medication and management strategies.
What it foundTreatment recommendations center on disease-modifying medicines and monitoring disease activity, with decisions informed by the patient’s circumstances and preferences.
What it can't tell usMany recommendations are conditional. It isn't a study of manual therapy, and symptom relief from hands-on care can't show that an autoimmune disease is under control.
Publication details & citation
Fraenkel et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care & Research. 2021. DOI: 10.1002/acr.24596.
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Exercise therapy for chronic low back pain
249 trials of exercise therapy in adults with chronic nonspecific low-back pain.
What it foundExercise probably improves pain compared with no treatment, usual care or placebo. Average improvements in function were smaller.
What it can't tell usThe programs, and what they were compared with, varied. The review doesn't point to one best exercise for everyone, and it doesn't apply to a new fracture, an infection or a neurological problem that's getting worse.
Publication details & citation
Hayden et al. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews. 2021. DOI: 10.1002/14651858.CD009790.pub2.
Read the publication recordBehavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline
Adults with chronic insomnia disorder, considering behavioral and psychological treatments.
What it foundThe guideline strongly recommends multicomponent cognitive behavioral therapy for insomnia. Sleep hygiene alone is not recommended as a single treatment.
What it can't tell usThe guideline covers insomnia care. It doesn't test chiropractic care, mattress brands or sleep apnea treatment, and ongoing sleep trouble may need its own medical assessment.
Publication details & citation
Edinger et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2021. DOI: 10.5664/jcsm.8986.
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Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial
148 adults with chronic nonspecific low-back pain, receiving 12 active or placebo sessions over four weeks; both groups received education.
What it foundThere was no clinically important difference in the primary pain and disability outcomes at four weeks.
What it can't tell usPatients, therapists and assessors were all blinded. It tested one protocol, so it doesn't show that every laser device performs the same, and it gives no support to claims that light regenerates a disc.
Publication details & citation
Guimarães et al. Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Pain. 2021. DOI: 10.1097/j.pain.0000000000002189.
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Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial
708 adults with a new episode of a rotator cuff disorder.
What it foundMore supervised exercise sessions did not improve the primary outcome over 12 months compared with a best-practice advice session. Injection offered no long-term benefit.
What it can't tell usThe advice session included home exercise and self-management. Major trauma and several other shoulder diagnoses were excluded, and it doesn't compare every shoulder treatment.
Publication details & citation
Hopewell et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial. The Lancet. 2021. DOI: 10.1016/S0140-6736(21)00846-1.
Read the publication recordEffectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis
Eight randomized trials in adults with lumbar radiculopathy (leg pain from an irritated nerve root), five of them pooled.
What it foundTraction given lying face up and added to physical therapy reduced pain and disability in the short term, up to three months. Traction given lying face down showed no significant effect in the higher-quality studies.
What it can't tell usThe face-up result came from low-quality studies, and it reaches only three months. It's evidence about traction added to physical therapy, not traction on its own.
Publication details & citation
Vanti et al. Effectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis. Physical Therapy. 2021. DOI: 10.1093/ptj/pzaa231.
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World Health Organization 2020 guidelines on physical activity and sedentary behaviour
Recommendations for children, adolescents, adults and older adults, including people living with selected chronic conditions or disability.
What it foundThe guideline recommends regular activity, strength work and less sedentary time. For adults, the general target is 150 to 300 minutes of moderate activity or 75 to 150 minutes of vigorous activity weekly.
What it can't tell usPopulation targets have to be adapted to a person's health, capacity and recovery, and some activity is better than none. The guideline doesn't test chiropractic care, and it isn't a rehabilitation plan for an injury.
Publication details & citation
Bull et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 2020. DOI: 10.1136/bjsports-2020-102955.
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Shock wave therapy for rotator cuff disease with or without calcification
32 trials, 2,281 participants with rotator cuff disease, most with calcific deposits; the main comparison was shock wave therapy against placebo at three months.
What it foundPain and function were slightly better with shock wave therapy than placebo, by less than the amount the authors considered clinically important. Adverse events were more frequent with treatment (41 of 156 versus 10 of 139 in five trials), with safety described as uncertain.
What it can't tell usEvery trial was susceptible to bias and none measured quality of life. The devices were extracorporeal or radial shock wave systems at varied doses; the result doesn't describe StemWave or any single device, dose or protocol.
Publication details & citation
Surace et al. Shock wave therapy for rotator cuff disease with or without calcification. Cochrane Database of Systematic Reviews. 2020. DOI: 10.1002/14651858.CD008962.pub2.
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Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee
156 patients with knee osteoarthritis in the US military health system.
What it foundPatients assigned physical therapy had less pain and disability at one year than those assigned glucocorticoid injection.
What it can't tell usIt was a physical therapy trial in one particular setting. It doesn't show cartilage regeneration, and it doesn't vouch for every treatment offered for knee pain.
Publication details & citation
Deyle et al. Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. New England Journal of Medicine. 2020. DOI: 10.1056/NEJMoa1905877.
Read the publication recordPhotobiomodulation therapy does not decrease pain and disability in people with non-specific low back pain: a systematic review
12 randomized trials with 1,046 people with non-specific low back pain, testing class I to III lasers and light-emitting diodes.
What it foundCompared with sham treatment, the effect on pain and disability was clinically unimportant, in recent and in long-lasting back pain alike.
What it can't tell usIt covers lower-power light only, not Class IV lasers, and some other outcomes rested on imprecise or low-quality evidence.
Publication details & citation
Tomazoni et al. Photobiomodulation therapy does not decrease pain and disability in people with non-specific low back pain: a systematic review. Journal of Physiotherapy. 2020. DOI: 10.1016/j.jphys.2020.06.010.
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No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews
41 systematic reviews and meta-analyses on spinal posture or physical exposure and low back pain, published 1990 to 2018.
What it foundBoth positive and null associations were reported for posture, sitting, standing, bending and heavy work. Reviews restricted to prospective studies were less able to reach consistent conclusions, and evidence that these factors precede first-time low back pain, or show a dose response, was lacking.
What it can't tell usA review of reviews inherits the definitions and the quality of the reviews it includes, which varied. It concerns low back pain, not neck pain.
Publication details & citation
Swain et al. No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. Journal of Biomechanics. 2020. DOI: 10.1016/j.jbiomech.2019.08.006.
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The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis
15 cross-sectional studies comparing forward head posture between people with and without neck pain, or correlating it with pain and disability.
What it foundAdults with neck pain showed more forward head posture than adults without it, and the posture correlated with pain intensity and disability in adults and older adults. In adolescents there was no such difference and no association with most neck pain measures.
What it can't tell usEvery included study was cross-sectional, so the review can't say whether the posture came before the pain or after it. Age confounded the relationship.
Publication details & citation
Mahmoud et al. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Current Reviews in Musculoskeletal Medicine. 2019. DOI: 10.1007/s12178-019-09594-y.
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Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial
204 adults aged 35 to 70 with confirmed gluteal tendinopathy.
What it foundEducation with load management and exercise improved pain and global recovery more at eight weeks. Global improvement remained better than injection at 52 weeks.
What it can't tell usAt 52 weeks, pain didn't differ significantly from the injection group. These results are about gluteal tendinopathy, not all hip pain or hip arthritis.
Publication details & citation
Mellor et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018. DOI: 10.1136/bmj.k1662.
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The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial
328 adults aged 18 to 65 with recurrent or persistent nonspecific low-back pain who had already responded favorably to initial care.
What it foundScheduled maintenance care was associated with about 13 fewer days of bothersome pain over one year than symptom-guided care, with more visits.
What it can't tell usThe trial was unblinded and only enrolled people who had already responded to care. It doesn't show a need for lifelong visits in healthy people, or any effect on immunity or disease prevention in general.
Publication details & citation
Eklund et al. The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. PLOS ONE. 2018. DOI: 10.1371/journal.pone.0203029.
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Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis
11 randomized trials, 802 patients with low-back pain and myofascial trigger points.
What it foundDry needling of trigger points reduced pain intensity and disability more than other treatments immediately after treatment, and dry needling plus other treatment did better for pain than dry needling alone.
What it can't tell usModerate evidence for the post-treatment effect only. The authors called the superiority for disability, and the effects at follow-up, unclear.
Publication details & citation
Liu et al. Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation. 2018. DOI: 10.1016/j.apmr.2017.06.008.
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Foot orthoses for plantar heel pain: a systematic review and meta-analysis
19 randomized trials, 1,660 adults with plantar heel pain, comparing foot orthoses with sham orthoses or other care.
What it foundAt 7 to 12 weeks there was moderate-quality evidence that foot orthoses reduced pain more than sham orthoses, with no improvement in function. Customised and prefabricated orthoses showed no difference at any time point.
What it can't tell usThe authors call it uncertain whether the pain difference is clinically important. Before 6 weeks and after 12 weeks the evidence was very low quality and showed no benefit for pain or function. It doesn't describe any one brand of orthotic.
Publication details & citation
Whittaker et al. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. British Journal of Sports Medicine. 2018. DOI: 10.1136/bjsports-2016-097355.
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Do schoolbags cause back pain in children and adolescents? A systematic review
69 studies involving 72,627 children and adolescents, including five prospective studies.
What it foundThe review found no convincing evidence that schoolbag weight, design or carrying method increased the risk of back pain.
What it can't tell usMost studies were cross-sectional or retrospective, and the prospective studies had moderate to high risk of bias. None of that makes a bag that hurts to carry something to ignore, or persistent pain in a child something that needs no assessment.
Publication details & citation
Yamato et al. Do schoolbags cause back pain in children and adolescents? A systematic review. British Journal of Sports Medicine. 2018. DOI: 10.1136/bjsports-2017-098927.
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Workplace interventions for reducing sitting at work
34 studies involving 3,397 workers in the June 2018 review.
What it foundLow-quality evidence suggested sit-stand desks reduced sitting time in the short and medium term. Results for several other workplace interventions were uncertain.
What it can't tell usThe review measured sitting time, and sitting less isn't the same as preventing back pain. This edition had no evidence on effects past one year, and the publisher links a later update.
Publication details & citation
Shrestha et al. Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews. 2018. DOI: 10.1002/14651858.CD010912.pub4.
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Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians
Adults with acute, subacute or chronic low-back pain considering noninvasive management.
What it foundThe guideline prioritizes non-drug options for chronic low-back pain, including exercise. Spinal manipulation is one of several options, supported by lower-quality evidence.
What it can't tell usA guideline pulls together existing evidence; it doesn't report a new experiment. It doesn't establish disc realignment, a cure for everyone, or superiority over all other care.
Publication details & citation
Qaseem et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 2017. DOI: 10.7326/M16-2367.
Read the publication recordRead this research in context (15)
- Back Pain
- Work Injury
- General Chiropractic Care
- Are You Looking for a Chiropractic Clinic in Clarksville TN
- 4 Ways Choosing a Chiropractor in Clarksville TN is Beneficial
- What Can a Chiropractor in Clarksville TN Help With?
- Are You in Search of a Chiropractor in Clarksville TN
- Do Chiropractors Just Help Back Pain in Clarksville TN
- Tips for Beating Back Pain in Clarksville TN
- 3 Common Conditions Chiropractic Care in Clarksville TN Can Help
- Back Pain Relief with Chiropractic in Clarksville TN
- How to Choose a Clarksville TN Chiropractor
- Lower Back
- Center of the lower back
- One side of the lower back
Complications of extracorporeal shockwave therapy in plantar fasciitis: Systematic review
39 studies, 2,493 patients with plantar fasciitis, receiving roughly 6,400 shock wave treatment sessions across a wide range of energy settings.
What it foundTwo complications were recorded in the whole series: precordial (chest) pain, and a superficial skin infection after regional anaesthesia. 225 patients reported pain during treatment and 247 reported transient red skin afterwards; transient pain, swelling, bruising, petechiae, altered sensation and severe headache were also reported.
What it can't tell usThe authors conclude shock wave therapy is likely safe for plantar fasciitis, with no complications expected at one year. Follow-up averaged 14.7 months and they call long-term complications unknown. The devices and doses varied widely; the result describes shock wave therapy for one condition, not StemWave or any single device.
Publication details & citation
Roerdink et al. Complications of extracorporeal shockwave therapy in plantar fasciitis: Systematic review. International Journal of Surgery. 2017. DOI: 10.1016/j.ijsu.2017.08.587.
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Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial
104 people with migraine, assigned spinal manipulation, sham treatment or usual pharmacological management.
What it foundMigraine days decreased in all groups, with no significant between-group difference in the primary outcome. The authors considered the observed manipulation effect probably a placebo response.
What it can't tell usIt was a small trial. Its secondary outcomes don't overturn the main result, and a trial this size is too small to show how often rare serious harms happen.
Publication details & citation
Chaibi et al. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. European Journal of Neurology. 2017. DOI: 10.1111/ene.13166.
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The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis
13 randomized trials of dry needling performed by physical therapists for musculoskeletal pain, compared with sham, no treatment or another intervention.
What it foundIn the immediate to 12-week period, dry needling may reduce pain and raise pressure pain threshold compared with sham or no treatment. At 6 to 12 months the difference was not statistically significant, and it was not superior to other treatments for function.
What it can't tell usEvidence was rated very low to moderate quality. The trials were of physical therapists using mixed techniques across mixed conditions; the result does not describe every needle placed by every clinician.
Publication details & citation
Gattie et al. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2017. DOI: 10.2519/jospt.2017.7096.
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Prevention of Low Back Pain: A Systematic Review and Meta-analysis
21 randomized trials involving 30,850 participants, examining interventions to prevent low-back pain.
What it foundExercise with education reduced the risk of a low-back-pain episode. Education alone, back belts and shoe insoles did not show a preventive effect.
What it can't tell usEvidence quality varied by intervention and outcome, and the search ended in 2014. It doesn't suggest every injury can be prevented, and it doesn't show that routine adjustments prevent back pain.
Publication details & citation
Steffens et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine. 2016. DOI: 10.1001/jamainternmed.2015.7431.
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- Clarksville TN Chiropractor Has 3 Tips
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- Clarksville TN Chiropractor Discusses a Healthier Spine
Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review
Studies of stretching before activity in healthy, physically active participants.
What it foundStretching can increase range of motion acutely. Longer static stretches immediately before performance had larger performance reductions than shorter holds; the surrounding warm-up mattered.
What it can't tell usThese are mostly immediate responses in healthy people. More range of motion doesn't automatically mean less pain, and the findings don't establish stretching as a treatment for an injured tendon, an unstable joint or an irritated nerve.
Publication details & citation
Behm et al. Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Applied Physiology, Nutrition, and Metabolism. 2016. DOI: 10.1139/apnm-2015-0235.
Read the publication recordRead this research in context (7)
- Clarksville TN Chiropractors Help Range of Motion
- Chiropractor in Clarksville TN Discusses Stretching
- Clarksville TN Chiropractor Has 3 Tips
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- Sports And Chiropractic in Clarksville TN
- Fitness Tips From a Chiropractor in Clarksville TN
- Athletes in Clarksville TN Excel with Chiropractic Care
Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis
48 randomized trials in adults with TMD comparing manual therapy or exercise with placebo, other treatments or standard care.
What it foundManual therapy, alone or combined with exercise, at the jaw or the neck showed promising effects. The review measured pain, range of motion and oral function, and most effect sizes were low to moderate.
What it can't tell usThe overall evidence was rated low, the trials had unclear or high risk of bias, and no high-quality evidence was found, so the authors concluded there's great uncertainty about how well these treatments work.
Publication details & citation
Armijo-Olivo et al. Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Physical Therapy. 2016. DOI: 10.2522/ptj.20140548.
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The Effectiveness of Mechanical Traction Among Subgroups of Patients With Low Back Pain and Leg Pain: A Randomized Trial
120 people with low-back pain and signs of lumbar nerve root compression, treated with extension-oriented exercise with or without mechanical traction, up to 12 visits over six weeks.
What it foundBoth groups improved, and adding traction made no difference to pain or disability at six weeks, six months or one year, including in the subgroup expected to respond.
What it can't tell usIt tested traction added to one exercise approach in physical therapy clinics, so it doesn't show how traction compares with no treatment at all.
Publication details & citation
Thackeray et al. The Effectiveness of Mechanical Traction Among Subgroups of Patients With Low Back Pain and Leg Pain: A Randomized Trial. Journal of Orthopaedic & Sports Physical Therapy. 2016. DOI: 10.2519/jospt.2016.6238.
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Systematic literature review of imaging features of spinal degeneration in asymptomatic populations
33 studies reporting imaging findings in 3,110 people without symptoms.
What it foundDegenerative findings were common in people without pain and became more frequent with age. A scan needs interpretation alongside symptoms and examination findings.
What it can't tell usThat doesn't make every disc finding harmless, or imaging never necessary. And a review like this can't identify what's causing one person's pain.
Publication details & citation
Brinjikji et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015. DOI: 10.3174/ajnr.A4173.
Read the publication recordRead this research in context (11)
- Back Pain
- Sciatica
- Disc Injury
- Do You Have a Slipped Disc in Clarksville TN?
- Clarksville TN Chiropractor Discusses Herniated Discs
- Clarksville TN Chiropractor Talks About Bulging Discs
- Do Chiropractors Just Help Back Pain in Clarksville TN
- Sciatic Leg Pain in Clarksville TN
- Lower Back
- Center of the lower back
- Pain traveling into the leg
Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial
84 people with plantar heel pain of at least one month, given real or sham trigger point dry needling once a week for six weeks.
What it foundAt six weeks, real dry needling reduced first-step pain and foot pain more than sham needling. Minor, short-lived adverse events followed 32% of real needling appointments and under 1% of sham appointments.
What it can't tell usThe difference between the groups was smaller than the minimal important difference, and the therapist couldn't be blinded. The authors say the effect should be weighed against how often the minor adverse events happened.
Publication details & citation
Cotchett et al. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Physical Therapy. 2014. DOI: 10.2522/ptj.20130255.
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Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists
39 physiotherapists in Ireland trained in trigger point dry needling, recording 7,629 treatments over ten months.
What it foundMild adverse events followed 19% of treatments: bruising (7.6%), bleeding (4.7%), pain during treatment (3.0%) and pain afterwards (2.2%) were the common ones. No significant adverse event occurred, giving an estimated upper risk of 0.04% or less.
What it can't tell usOne training lineage, one country, and clinicians reporting on themselves. A survey that records no serious event over 7,629 treatments puts a ceiling on the risk; it doesn't show the risk is zero, and case reports elsewhere document serious harm.
Publication details & citation
Brady et al. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. Journal of Manual & Manipulative Therapy. 2014. DOI: 10.1179/2042618613Y.0000000044.
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Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial
86 people with neck pain and signs of cervical radiculopathy (arm symptoms from a neck nerve root), given four weeks of exercise alone, exercise with mechanical traction, or exercise with over-door traction.
What it foundAdding mechanical traction to exercise was followed by lower neck disability at six and twelve months than exercise alone, and lower than over-door traction at six months.
What it can't tell usIt's a single trial of 86 people with arm symptoms from the neck, and the twelve-month difference was less certain than the six-month one. It doesn't speak for neck pain without arm symptoms, or for traction without exercise.
Publication details & citation
Fritz et al. Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy. 2014. DOI: 10.2519/jospt.2014.5065.
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Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial
172 people with grade I or II whiplash lasting more than three months.
What it foundAn intensive exercise program did not improve pain more than an advice session with telephone support at the measured follow-ups.
What it can't tell usIt compares two specific approaches to chronic whiplash. It isn't evidence that all exercise is useless, and it doesn't cover every acute injury.
Publication details & citation
Michaleff et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. The Lancet. 2014. DOI: 10.1016/S0140-6736(14)60457-8.
Read the publication recordEffect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial
165 adults with lateral elbow pain lasting more than six weeks.
What it foundSteroid recipients had lower recovery and more recurrence at one year than placebo recipients. Physiotherapy did not significantly change one-year recovery or recurrence.
What it can't tell usThe results apply to these approaches to persistent lateral elbow pain. They don't show that chiropractic care is superior.
Publication details & citation
Coombes et al. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013. DOI: 10.1001/jama.2013.129.
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A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy
169 pregnant participants enrolled at 24 to 28 weeks, with outcomes assessed at 33 weeks.
What it foundManual therapy, stabilization exercise and education alongside obstetric care improved pain and disability compared with standard obstetric care alone.
What it can't tell usBecause the program combined several things, it can't separate out the effect of an adjustment. It doesn't show a benefit for delivery, fetal position or the baby's health. The publication record links a correction.
Publication details & citation
George et al. A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. American Journal of Obstetrics and Gynecology. 2013. DOI: 10.1016/j.ajog.2012.10.869.
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Effects of bracing in adolescents with idiopathic scoliosis
242 adolescents with the usual indications for bracing, in randomized and patient-preference groups.
What it foundIn the randomized group, 75% assigned bracing versus 42% assigned observation reached skeletal maturity without progression to a curve of at least 50 degrees.
What it can't tell usIt supports appropriate orthopedic assessment and bracing for selected adolescents. It gives no evidence that adjustments reverse scoliosis.
Publication details & citation
Weinstein et al. Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine. 2013. DOI: 10.1056/NEJMoa1307337.
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A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder
80 participants with chronic muscle-related TMD, assigned a dental splint, Activator Method chiropractic adjustment, a sham adjustment or self-care only, all with a self-care program.
What it foundPain went down by a similar amount in all four groups over six months, and the chiropractic group did not do better than the sham group.
What it can't tell usIt was a pilot built to test whether a larger trial could be run, not to compare the treatments, and only 52 people completed the six-month assessment.
Publication details & citation
DeVocht et al. A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder. Journal of the American Dental Association. 2013. DOI: 10.14219/jada.archive.2013.0034.
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Is there relationship between temporomandibular disorders and head and cervical posture? A systematic review
17 studies on the association between head and neck posture and TMD.
What it foundThe relationship between TMD and head and neck posture remained controversial and unclear.
What it can't tell usMany of the studies had methodological flaws, and too few were of high quality to accept or rule out a link.
Publication details & citation
Rocha et al. Is there relationship between temporomandibular disorders and head and cervical posture? A systematic review. Journal of Oral Rehabilitation. 2013. DOI: 10.1111/joor.12104.
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Traction for low-back pain with or without sciatica
32 randomized trials involving 2,762 people with low-back pain, with or without sciatica, using manual or machine traction.
What it foundTraction, alone or added to other treatment, made little or no difference to pain, function or overall improvement. Seven trials reported adverse effects, including increased pain, worsening nerve signs and later surgery.
What it can't tell usThe evidence was searched through 2012, the trials were small and many had moderate to high risk of bias, and the review didn't test any one branded table.
Publication details & citation
Wegner et al. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews. 2013. DOI: 10.1002/14651858.CD003010.pub5.
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Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial
272 adults with nonspecific neck pain lasting 2 to 12 weeks.
What it foundManipulation performed better than medication at several follow-ups, but there was no important pain difference between manipulation and home exercise with advice.
What it can't tell usTreatment was unblinded. The study doesn't cover every cause of neck pain, instability after trauma, or an unexplained neurological problem.
Publication details & citation
Bronfort et al. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of Internal Medicine. 2012. DOI: 10.7326/0003-4819-156-1-201201030-00002.
Read the publication recordRead this research in context (12)
- Neck Pain
- Arm and Leg Pain
- General Chiropractic Care
- 4 Ways Choosing a Chiropractor in Clarksville TN is Beneficial
- What Can a Chiropractor in Clarksville TN Help With?
- How Can Chiropractic Care Help Posture in Clarksville TN
- Neck Pain – The Cause and the Options in Clarksville TN
- Neck
- Upper neck
- Side of the neck
- Base of the neck
- Around the shoulder blade
A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial
401 adults with chronic nonspecific low-back pain.
What it foundStructural and relaxation massage both improved function and symptom bothersomeness at ten weeks compared with usual care.
What it can't tell usParticipants knew whether they received massage. Neither style was meaningfully superior, and benefits at one year were limited.
Publication details & citation
Cherkin et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Annals of Internal Medicine. 2011. DOI: 10.7326/0003-4819-155-1-201107050-00002.
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Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial
522 athletes aged 12 to 70 with a recent lateral ankle sprain, receiving usual care with or without an eight-week home balance program.
What it foundOver one year, 22% of the training group reported another sprain, compared with 33% of the usual-care group.
What it can't tell usRecurrences were self-reported. It backs rehabilitation after an ankle sprain, but it didn't test manipulation, and it doesn't show immediate pain relief.
Publication details & citation
Hupperets et al. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009. DOI: 10.1136/bmj.b2684.
Read the publication recordNo effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy
60 people with chronic low-back pain thought to come from the disc, in a graded activity program, given 20 sessions of IDD Therapy traction or a sham traction weight.
What it foundBoth groups improved in back pain, leg pain, disability and quality of life at 14 weeks, and active traction did no better than the sham on any of them.
What it can't tell usIt studied chronic low back pain, not sciatica, so it says nothing about leg pain from an irritated nerve root. It tested one protocol on one machine, and nothing in it backs claims of disc regeneration.
Publication details & citation
Schimmel et al. No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy. European Spine Journal. 2009. DOI: 10.1007/s00586-009-1044-3.
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Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health
54 epidemiological studies of the relationship between sagittal spinal curves (the side-on shape of the spine) and health outcomes, including spinal pain.
What it foundNo strong evidence of an association between sagittal spinal curves and any health outcome, including spinal pain. The included studies were generally of low methodological quality.
What it can't tell usPublished in 2008 and, being a review of observational studies, unable to say whether a curve causes anything even where an association was found.
Publication details & citation
Christensen & Hartvigsen Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. Journal of Manipulative and Physiological Therapeutics. 2008. DOI: 10.1016/j.jmpt.2008.10.004.
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Surgery versus prolonged conservative treatment for sciatica
283 patients with severe sciatica lasting 6 to 12 weeks, assigned early surgery or prolonged conservative care with surgery if needed.
What it foundEarly surgery provided faster relief and recovery, while one-year outcomes were similar.
What it can't tell usAbout 39% of those first assigned conservative care went on to have surgery. It wasn't a chiropractic trial, and it doesn't show that any treatment shrinks discs or guarantees avoiding surgery.
Publication details & citation
Peul et al. Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine. 2007. DOI: 10.1056/NEJMoa064039.
Read the publication recordRead this research in context (10)
- Sciatica
- Disc Injury
- Do You Have a Slipped Disc in Clarksville TN?
- Clarksville TN Chiropractor Discusses Herniated Discs
- Clarksville TN Chiropractor Talks About Bulging Discs
- Benefits of Spinal Decompression in Clarksville TN
- Do Chiropractors Just Help Back Pain in Clarksville TN
- Sciatic Leg Pain in Clarksville TN
- Pain traveling into the leg
- Buttock & back of the pelvis
Short-term efficacy of Epley's manoeuvre: a double-blind randomised trial
66 people with confirmed posterior-canal benign paroxysmal positional vertigo (BPPV).
What it foundAt 24 hours, 80% receiving the Epley maneuver had neither vertigo nor nystagmus on positional testing, compared with 10% receiving the sham procedure.
What it can't tell usIt was a short-term test of one repositioning maneuver for one specific diagnosis. There's nothing in it that supports neck manipulation for unexplained dizziness.
Publication details & citation
von Brevern et al. Short-term efficacy of Epley's manoeuvre: a double-blind randomised trial. Journal of Neurology, Neurosurgery & Psychiatry. 2006. DOI: 10.1136/jnnp.2005.085894.
Read the publication recordRead this research in context (1)
Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests
48 patients assessed with clinical provocation tests and intra-articular anesthetic injections.
What it foundA cluster of pain-provoking tests was more useful than relying on a single finding to identify SI-joint pain in this sample.
What it can't tell usThe sample was small and selected. It's research on diagnosis, so it doesn't prove a pelvic misalignment or that any treatment works.
Publication details & citation
Laslett et al. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual Therapy. 2005. DOI: 10.1016/j.math.2005.01.003.
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Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study
101 patients with plantar fasciitis lasting at least ten months.
What it foundPlantar fascia-specific stretching improved worst pain and first-step pain more at eight weeks than Achilles stretching.
What it can't tell usOnly 82 patients came back for follow-up, and the two groups differed at the start in how long they'd had symptoms. Both groups also got insoles, medication and education, so the results can't be put down to stretching alone, or applied to every heel problem.
Publication details & citation
DiGiovanni et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. Journal of Bone and Joint Surgery. 2003. DOI: 10.2106/00004623-200307000-00013.
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A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache
200 people with cervicogenic headache, assigned to manipulation, specific exercise, both, or a control group.
What it foundManipulative therapy and exercise each reduced headache frequency and intensity, with benefits reported at 12 months.
What it can't tell usParticipants weren't blinded, and the combined approach wasn't significantly superior. The findings are about headache that starts in the neck (cervicogenic headache), not migraine in general.
Publication details & citation
Jull et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002. DOI: 10.1097/00007632-200209010-00004.
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- Headaches & Migraines
- 4 Ways Choosing a Chiropractor in Clarksville TN is Beneficial
- What Can a Chiropractor in Clarksville TN Help With?
- 3 Common Conditions Chiropractic Care in Clarksville TN Can Help
- Chiropractor in Clarksville TN Talks About Headaches
- Headache Tips From a Clarksville TN Chiropractic Office
- Clarksville TN Chiropractors May Relieve Migraines
- Clarksville TN Chiropractor Discusses Different Types of Headaches
- Headaches – You Don’t Need to Suffer in Clarksville TN
- Back of the head
- Upper neck
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