The Effectiveness of Spinal Manipulative Therapy in Treating Spinal Pain Does Not Depend on the Application Procedures: A Systematic Review and Network Meta-analysis
PainSci notes on Nim 2025:
SKEPTICS: Spinal manipulation is a big ol’ nothing burger.
SPINAL ADJUSTMENT FANS: It’s all in the wrist. Got to do it right. You just suck at it.
THIS BIG SCIENTIFIC REVIEW: Nope, doesn’t matter how you manipulate the spine. “None of the SMT procedures were superior to others in terms of pain relief.”
Sooooo much energy poured into spinal manipulation “technique” over the years without much to show for it! Nothing at all, apparently.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: Spinal manipulative therapy (SMT) is commonly used to treat spinal pain, but it is unclear whether the effectiveness of SMT depends on the application procedures.
OBJECTIVE: To assess the effectiveness of different SMT application procedures for the treatment of spinal pain.
METHODS: We conducted a systematic review and network meta-analysis of randomized controlled trials comparing different SMT application procedures in individuals with spinal pain. Data sources included PubMed, EMBASE, and Cochrane Central Register of Controlled Trials up to January 2024. Two reviewers independently screened studies, extracted data, and assessed risk of bias. The primary outcome was pain intensity measured within 3 months post-intervention.
RESULTS: Thirty-five trials (n=4,678 participants) were included. No significant differences in pain reduction were found between different SMT application procedures. The network meta-analysis showed that none of the SMT procedures were superior to others in terms of pain relief.
CONCLUSION: The effectiveness of SMT in treating spinal pain does not depend on the specific application procedures. Clinicians may choose SMT techniques based on patient preference, clinician experience, and other contextual factors.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
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