Osteopathy and Chiropractic no longer recommended as a first line treatment for low back pain or sciatica

If you ask a member of the public what osteopaths and chiropractors treat you will probably get the answer “bad backs”. It is true that most people who go to an osteopath or a chiropractor do so because of back pain. However, the treatments offered by osteopaths and chiropractors are no longer considered to be first-line treatments for low back pain or sciatica. The recently published NICE guidelines for low back pain and sciatica emphasize exercise as being central to the treatment approach.

Manual therapy, such as that provided by osteopaths and chiropractors, can only be considered in addition to an exercise programme. Manual therapy should not be offered in isolation. This is a “downgrading” of the role of osteopathy and chiropractic in the treatment of low back pain as those treatments were previously considered as a valid alternative to exercise. What has brought about this change? Quite simply, evidence. Recent research has shown that osteopathy and chiropractic (manual therapy) are not an effective treatment in isolation for low back pain and sciatica. Any osteopath or chiropractor who recommends their treatments to a patient who is not already following an exercise programme is not following the NICE guidelines. This brings into question whether they are acting in the best interest of the patient.

The right person to deliver an exercise programme is of course a physiotherapist. Physiotherapy is available on the NHS via a referral from a GP. Alternatively, private physiotherapy is available and it’s easy to search for a suitable physio on the Chartered Society of Physiotherapy website.

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