Low Back Pain

  • A 2019 randomized comparative effectiveness trial with 259 patients with a mean age of 72 investigated 3 nonsurgical interventions for lumbar spine stenosis (LSS). Adjusted between-group analyses at 2 months showed manual therapy with individualized exercise had greater improvement of symptoms and physical function compared with medical care or group exercise. At 6 months, there were no between-group differences in mean outcome scores or responder rates. Conclusion: Manual therapy with individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity.1
  • A 2019 randomized comparative effectiveness trial with 241 patients aged 65 and older with sub-acute or chronic low back pain (LBP) investigated adding spinal manipulative therapy (SMT) or supervised rehabilitative exercise to home exercise in adults 65 or older. It found that adding SMT or supervised rehabilitative exercise to home exercise alone does not appear to improve pain or disability in the short- or long-term for older adults with chronic low back pain, but did enhance satisfaction with care.2
  • A 2019 systematic review assessed all available interventions used to manage non-specific low back pain (NSLBP) in adults aged 60 or older. 18 randomized controlled trials were included. It concluded that the evidence about interventions for NSLP in older adults is limited and new studies are highly likely to change these results.3
  • A 2017 systematic review assessed the effectiveness and safety of manual therapy interventions on pain and disability in older persons with chronic low back pain (CLBP). 4 randomized controlled trials were included. It concluded that the current evidence to make firm clinical recommendations is limited.4

Spinal/Back and Neck Pain and Disability

  • A 2018 randomized controlled trial with 182 patients aged 65 or older compared short-term treatment (12 weeks) versus long-term management (36 weeks) of back and neck related disability in older adults using spinal manipulative therapy (SMT) combined with supervised rehabilitative exercises (SRE). It concluded that for older adults with chronic back and neck disability, extending management with SMT and SRE from 12 to 36 weeks did not result in any additional important reduction in disability.5

Best Practice Recommendations

  • This 2017 study was to update its 2010 evidence-based recommendations on the best practices for chiropractic care of older adults. The project consisted of a systematic literature review and a consensus process to provide a summary of evidence-informed best practices for doctors of chiropractic for the evaluation, management, and manual treatment of older adult patients.6


  1. Schneider MJ, Ammendolia C, Murphy DR, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA network open. 2019;2(1):e186828. FREE FULL TEXT
  2. Schulz C, Evans R, Maiers M, Schulz K, Leininger B, Bronfort G. Spinal manipulative therapy and exercise for older adults with chronic low back pain: a randomized clinical trial. Chiropr Man Therap. 2019;27:21. FREE FULL TEXT
  3. Nascimento P, Costa LOP, Araujo AC, Poitras S, Bilodeau M. Effectiveness of interventions for non-specific low back pain in older adults. A systematic review and meta-analysis. Physiotherapy. 2019;105(2):147-162. FREE FULL TEXT
  4. de Luca KE, Fang SH, Ong J, Shin KS, Woods S, Tuchin PJ. The Effectiveness and Safety of Manual Therapy on Pain and Disability in Older Persons With Chronic Low Back Pain: A Systematic Review. J Manipulative Physiol Ther. 2017;40(7):527-534. FREE FULL TEXT
  5. Maiers M, Hartvigsen J, Evans R, et al. Short or long-term treatment of spinal disability in older adults with manipulation and exercise. Arthritis Care Res. 2018. FREE FULL TEXT
  6. Hawk C, Schneider MJ, Haas M, et al. Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update. J Manipulative Physiol Ther. 2017;40(4):217-229. FREE FULL TEXT