Spinal manipulation reduces pain (decreasing the need for medication in some cases), rapidly advances physical therapy, and requires very few passive forms of treatment. It is recommended that low back pain sufferers choose the most conservative care first. Spinal manipulation has been known to be the only safe and effective, drugless form of initial professional treatment for acute low back problems in adults. Research has shown that there is strong evidence that spinal manipulation for back pain is just as effective as a combination of medical care and exercise. In some cases, it has been noted that spinal manipulation is just as effective as prescription NSAIDS combined with exercise. An article published in the Journal of the American Medical Association in 2013 suggested chiropractic care as an option for people suffering from low back pain. It was noted that surgery is usually not needed and should only be tried if other therapies fail.

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