University of Florida, Gainesville, FL, USA.
Am Fam Physician. 2019 Feb 15;99(4):248-252.
Manipulative therapies include osteopathic manipulative treatment and many other forms of manual therapies used to manage a variety of conditions in adults and children. Spinal manipulative therapy may provide short-term improvement in patients with acute or chronic low back pain, comparable with other standard treatments. When compared with oral analgesics, cervical manipulation and/or mobilization appears to provide better short-term pain relief and improved function in patients with neck pain. Manipulative therapies may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intensity of pain. Although manipulative therapy is sometimes recommended to treat conditions in children (e.g., musculoskeletal problems, otitis media, respiratory conditions, infantile colic, allergies), there is supporting evidence only for reducing the length of hospital stay for preterm infants. Mild adverse events, such as muscle stiffness and soreness, occur in up to 50% of adults who undergo manipulative therapy. Although serious adverse events such as lumbar disk herniation, cauda equina syndrome, and vertebrobasilar injury are rare, they can cause significant disability or death. Given the limited proven benefits of manipulative therapies and small risk of serious adverse events, additional high-quality, adequately powered studies are needed before definitive recommendations can be made for treating many conditions.
手法治疗包括整骨疗法和许多其他形式的手动治疗，用于治疗成人和儿童的各种疾病。脊柱手法治疗可能会为急性或慢性腰痛患者提供短期改善，与其他标准治疗相当。与口服镇痛药相比，颈椎手法治疗和/或松动术似乎可以为颈痛患者提供更好的短期疼痛缓解和功能改善。手法治疗可能与阿米替林一样有效治疗偏头痛，并能减少疼痛的频率和强度。虽然有时推荐手法治疗来治疗儿童的疾病（例如，肌肉骨骼问题、中耳炎、呼吸道疾病、婴儿绞痛、过敏），但仅支持缩短早产儿的住院时间。高达 50%接受手法治疗的成年人会出现轻度不良反应，如肌肉僵硬和酸痛。尽管腰椎间盘突出症、马尾综合征和椎基底动脉损伤等严重不良反应很少见，但它们可能导致严重残疾或死亡。鉴于手法治疗的益处有限，且严重不良反应的风险较小，在为许多疾病提供明确治疗建议之前，还需要进行更多高质量、充分效力的研究。
