From Fringe to First-Line: 50 Years of Evidence Now Defining Spinal Manipulation as Standard Care

In this episode of PCA Deep Dive, we explore a recent 2024 narrative review from the Journal of Clinical Medicine, focusing on spinal manipulation and chiropractic practice. Analyzing over 50 years of research and more than 6,000 studies, we examine the modern evidence on spinal manipulative therapy (SMT) and its role, safety, and clinical value in musculoskeletal care. We discuss the evolving academic focus from defensive research to high-quality methods, such as randomized controlled trials (RCTs) and systematic reviews, leading to robust clinical practice guidelines (CPGs) that strongly support SMT for conditions such as low back pain (LBP), neck pain, cervicogenic headaches, and tension-type headaches. We also address historical safety concerns and the current evidence indicating a low risk of adverse events. The episode underlines SMT’s position within integrated, evidence-based conservative care and highlights ongoing research pushing its application even further into general healthcare.

00:00 Introduction to PCA Deep Dive

00:58 Unpacking the Evidence: Spinal Manipulation and Chiropractic Practice

02:34 Historical Context and Research Evolution

05:23 Clinical Practice Guidelines and Recommendations

07:45 Expanding the Scope: Beyond Spine Care

09:15 Addressing Safety Concerns and Value Proposition

13:24 Conclusion and Future Directions

Primary Evidence Source

Clinical Practice Guidelines for Spinal Manipulative Therapy: A Narrative ReviewJournal of Clinical Medicine, 2024

This comprehensive narrative review analyzes more than 50 years of chiropractic and SMT research, mapping the profession’s progression from early regulatory and safety inquiries to modern guideline-supported clinical practice. The authors reviewed:

• 6,286 chiropractic-related publications spanning 1972–2024
• 33 clinical practice guidelines published between 2013 -2024
• 59 distinct guideline recommendations related to spinal manipulative therapy

Key findings include:

• Strong guideline support for SMT in low back pain and neck pain, particularly when delivered as part of multimodal, conservative care
• Demonstrated maturation of research quality, with a shift toward randomized controlled trials and systematic reviews
• No definitive causal link between SMT and serious vascular adverse events, with overall risk classified as rare
• Increasing alignment with value-based care goals, including reduced downstream imaging, medication use, and surgery

Direct link to the study:https://doi.org/10.3390/jcm13055668

PCA Website:https://pennchiro.org/

PCA Email:pca@pennchiro.org

Disclosure

The Pennsylvania Chiropractic Association did not generate this data. PCA Deep Dive reviews and discusses independent, peer-reviewed research to translate long-term outcomes and clinical implications for patients, clinicians, policymakers, and healthcare decision-makers.