There is moderate evidence that spinal manipulative therapy/mobilization are superior to general practitioner management for short-term pain reduction. Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical Low-Back disorders. There is a large volume of moderate evidence to suggest that manual therapy is more cost effective when compared with traditional education and medication. Given the evidence that SMT alone may be no more effective when compared to standard medical tx, safety and patient preferences must be accounted for.

Essential Literaure

A COMPARISON OF SPINAL MANIPULATION METHODS AND USUAL MEDICAL CARE FOR ACUTE AND SUB-ACUTELOW BACK PAIN
Schneider et. al. 2015
Conclusion:
Manual-Thrust Manipulation provides great short-term reductions in self-reported disability and pain scores compared to Mechanical-Assisted Manipulation or Usual Medical Care.

DOSE-RESPONSE AND EFFICACY OF SPINAL MANIPULATION FOR CARE OF CHRONIC LOW BACK PAIN: A RANDOMIZED CONTROLLED TRIAL
Haas M et. al 2014
Conclusion:
The number of spinal manipulation visits had modest effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor. Overall, 12 visits yielded the most favorable results but was not well distinguished from other dose levels.

CHIROPRACTIC AND MEDICAL TREATMENT ON THE HEALTH OF OLDER ADULTS
Weigel et.al. 2014
Conclusion:
The findings from this study suggest that chiropractic use in episodes of care for uncomplicated back conditions has protectiveeffects against declines in ADLs, instrumental ADLs, and self-rated health for older Medicare beneficiaries over a 2-year period.

COST-EFFECTIVENESS OF MANUAL THERAPY FOR THE MANAGEMENT OF MUSCULOSKELETAL CONDITIONS
Tsertsvadze et. al. 2014
Conclusion:
Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care

MYOFASCIAL LOW BACK PAIN TREATMENT
Sharan et. al 2014
 Conclusion:
In this literature review, relatively few recent studies were found focusing on the treatment of MLBP. Also, no single treatment modality was found to be consistently effective for this condition. The reviews pointed toward a multidisciplinary approach for the treatment of MLBP. Further studies are required to determine the optimal treatment of MLBP with a multidisciplinary focus.

 
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TRACKING LOW BACK PROBLEMS IN A MAJOR SELF-INSURED WORKFORCE: TOWARD IMPROVEMENT IN THE PATIENT’S JOURNEY
Allen et. al. 2014
Conclusion:
Medical management and chiropractic reported the highest and lowest rates, respectively, of guideline-incongruent use of imaging, surgeries, and medications, and the highest and lowest total costs. Patients receiving chiropractic care have been found to record lower associations of probability of disability recurrence than patients of physicians and physical therapists.Chiropractic care with shorter duration has also been found to be associated with lower rates of disability recurrence and shorter disability duration. The Chiropractic approach, in contrast, was consistently linked to the lowest costs. Its per-employee total stayed at the lowest level across all three groups for each year.

CHIROPRACTIC USE IN THE MEDICARE POPULATION: 1-YEAR CHANGES IN HEALTH AND SATISFACTION WITH CARE
Weigel et.al. 2014
Conclusion:
This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

EFFECTIVENESS OF MANUAL THERAPY FOR MANAGEMENT OF MUSCULOSKELETAL CONDITIONS
Christine Clar et. al. 2014
Conclusion:
This systematic review updated and extended the “UK evidence report”  This is in essence the largest and most comprehensive review of the current best practices and effectiveness of musculoskeletal conditions and treatment. Each condition is broken down by evidence class reliability and treatment modality.

JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION SUGGESTS CHIROPRACTIC FOR LOW BACK PAIN
Goodman et. al. 2014
Conclusion:
An article in the Journal of the American Medical Association (JAMA) suggests patients try chiropractic services for the treatment of low back pain. According to the article, surgery is not usually needed and should only be considered if more conservative therapies fail. The information in JAMA reinforces the American Chiropractic Association’s (ACA) position that conservative care options should serve as a first line of defense against pain.

THE RELATIVE EFFECTIVENESS OF SEGMENT SPECIFIC LEVEL AND NON-SPECIFIC LEVEL SPINAL JOINT MOBILIZATION
Slaven et. al. 2013
Conclusion:
This systematic review supports the argument that joint mobilization to the spine does lead to an immediate effect on pain at rest and pain with the most painful movement. A meta-analysis of a subset of these studies did identify that the effect of mobilization relating to a specific level or non-specific level was different based on the region of the spine being treated; the direction of effect in the cervical spine was toward specific mobilization and in the lumbar spine towards non-specific mobilization, indicating body location modified the relationship between specific versus non-specific mobilization with pain at rest.

ADDING CHIROPRACTIC MANIPULATIVE THERAPY TO STANDARD MEDICAL CARE
Goertz et. al. 2013
Conclusion:
The results of this trial suggest that CMT in conjunction with SMC offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women with acute LBP.

COMPARING THE SATISFACTION OF LOW BACK PATIENTS MEDICAL V.S CHIROPRACTIC CARE
Hertzman et. al. 2002
Conclusion:
The mean satisfaction score for chiropractic patients was greater than the score for medical patients Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients’ satisfaction