The Chiropractic Doctors' Association of Hong Kong

Government Recommendation for Management Protocols

Bigos, S., Bowyer, O., Braen, G., et al. (1994) Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642. Rockville, MD; Agency for Health Care Policy and Research Public Health Service, U.S. Department of Health and Human Services.

In December 1994, the Agency for Health Care Policy and Research (AHCPR, a division of the US Department of Health and Human Services) released a clinical practice guideline entitled Acute Low Back Problems in Adults. The guideline was developed by a 23-member expert multidisciplinary panel, using rigorous scientific methodology. The guideline concluded that relief of discomfort of low back pain can be accomplished most safely by only two methods: non-prescription medication and/or spinal manipulation. Most other therapies currently in use for the treatment of low back pain were found to be either ineffective or unsubstantiated by scientific research. Side-effects associated with the use of medication were found to be greater than those associated with manipulation, which were very limited.

Spitzer, W.O., et al. (1995) Whiplash-Associated Disorders (WAD): Redefining Whiplash and its Management: Quebec Task Force on Whiplash-Associated Disorders.

The Quebec Task force consisted of an 18-member expert multidisciplinary panel whose mandate was to undertake a comprehensive review and study of whiplash-associated disorders (WAD). One of the sections of the report dealt with clinical guidelines for the diagnosis, treatment and prognosis of WAD. It was the Task Force consensus that the use of non-steroidal anti-inflammatory agents and analgesics, short-term manipulation and mobilization by trained persons and active exercises are useful in Grade II and III WAD, and that manipulative treatments by trained persons for the relief of pain and facilitating early mobility can be used in WAD.

Royal College of General Practitioners (1996) Clinical Guidelines for the Management of Acute Low Back Pain, Great Britain.

The Royal College of General Practitioners, in consultation with the Chartered Society of Physiotherapy, Osteopathic Association of Great Britain, British Chiropractic Association and the National Back Pain Association constructed clinical guidelines on low back pain management, based on extensive international scientific evidence. One of the principal recommendations of the guidelines is "to consider manipulative treatment within the first 6 weeks for patients who need additional help with pain relief or who are failing to return to normal activities" based on high level evidence that within the first six weeks of onset of acute or recurrent low back pain, manipulation provides better short-term improvement in pain and activity levels and higher patient satisfaction than the treatments to which it has been compared.