What chiropractic technique is most supported by current evidence-based research in Chiropractic (chiropractic) care?

From the Guidelines

Spinal manipulation therapy (SMT) is the chiropractic technique most supported by current evidence-based research in chiropractic care. This technique involves the application of controlled force to specific joints of the spine and has demonstrated effectiveness primarily for acute low back pain, neck pain, and some types of headaches 1. The evidence suggests that SMT works best when incorporated into a comprehensive treatment plan that includes exercise, patient education, and self-management strategies rather than being used in isolation.

Key aspects of SMT include:

• Short-term treatment courses (typically 6-12 sessions over 2-4 weeks) with clear therapeutic goals and regular reassessment of progress
• Neurophysiological effects such as altered pain perception, improved joint mobility, and muscle relaxation as the likely mechanism behind SMT's effectiveness
• The importance of seeking chiropractors who practice evidence-based care, stay current with research, and collaborate with other healthcare providers when appropriate

It's also important to note that the evidence is insufficient to conclude that benefits of manipulation vary according to the profession of the manipulator (chiropractor vs. other clinician trained in manipulation) or according to presence or absence of radiating pain 1. Therefore, the focus should be on the technique itself and its integration into a broader treatment plan, rather than the specific profession of the practitioner.

From the Research

Chiropractic Techniques Supported by Current Evidence-Based Research

• The most supported chiropractic technique is Spinal Manipulative Therapy (SMT), which has been shown to be effective in treating acute low back pain 2, 3, 4.
• SMT is defined as any hands-on therapy directed towards the spine, which includes both manipulation and mobilization, and includes studies from chiropractors, manual therapists, and osteopaths 3.
• High-velocity, low-amplitude spinal manipulation (HVLA-SM) is a specific type of SMT that has been studied, and training programs have been developed to standardize the dosing of this technique 5.
• The evidence suggests that SMT, including HVLA-SM, can achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up 2, 3, 4.

Key Findings

• A systematic review of 14 randomized controlled trials (RCTs) found that SMT was effective in treating acute low back pain, with significant improvements in pain and function compared to control groups 2.
• Another systematic review of 20 RCTs found that SMT was no more effective than inert interventions, sham SMT, or as adjunct therapy, but was safe and had no serious complications 3, 4.
• A pilot study found that an HVLA-SM training program was effective in improving the accuracy of participants' delivery of prescribed peak forces, but accuracy decreased 1 week after training 5.

Implications for Chiropractic Care

• Spine care clinicians should discuss the role of SMT as a treatment option for patients with acute low back pain who do not find adequate symptomatic relief with self-care and education alone 2.
• The decision to refer patients for SMT should be based upon costs, preferences of the patients and providers, and relative safety of SMT compared to other treatment options 3, 4.