No Difference Between Techniques
An international group of researchers analysed 161 studies involving nearly 12,000 participants to investigate whether the precision of spinal manipulation affects its effectiveness. SMT was compared to various interventions: recommended treatments, non-recommended treatments, sham (placebo) treatments, and no treatment. The data was analysed regarding short- and long-term follow-up on pain and function. The result seems clear: SMT reduces pain and improves function, but the researchers found no clinically relevant differences between different SMT methods, and the exact location of the treatment is not crucial. It seems that what matters most is that the treatment is performed, not where it is applied.
Good News for Practitioners and Patients
SMT is one of the most widely used treatments for back pain among chiropractors. Traditionally, many practitioners have been taught that a specific manipulation at a precise location is necessary for the best effect. This new study challenges that belief, as the researchers' data shows that it is not essential. According to the researchers, this new knowledge gives practitioners greater freedom to choose the method that best suits the patient—without fear of making the "wrong" choice. Their findings could make treatment more flexible and tailored to individual patients. The researchers also emphasize that chiropractic education should shift its focus from precise manipulation locations to safe and comfortable techniques.
The researchers encourage more high-quality research to explore the effectiveness of SMT in its different variations, emphasizing high-quality, clinically applicable SMT effectiveness studies.
Casper Nim et. al. The Effectiveness of Spinal Manipulative Therapy in Treating Spinal Pain Does Not Depend on the Application Procedures: A Systematic Review and Network Meta-analysis. JOSPT 2025.