The Top 10 Most Impactful SMT Studies in the Past Year

The Top 10 Most Impactful SMT Studies in the Past Year

Here are ten quick summaries of the most influential chiropractic-related research studies from the past year, as collected & defined by the blog.

Stroke Risk

Annals of Medicine: “Manual therapy does not result in an increased risk of CAD [cervical artery dissection].”


Chaibi A et al. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review. Ann Med. 2019 Mar 19:1-27.


Researchers from Harvard Medical School, Brigham & Women’s Hospital, and Palmer College of Chiropractic performed a systematic review of the effectiveness of SMT for migraine and concluded that: “We observed that spinal manipulation reduced migraine days…as well as migraine pain intensity.”

Rist PM et al. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache. 2019 Apr;59(4):532-542.

Neck Pain

A systematic review of 47 randomized trials found that cervical manipulation is safe and effective:

  • An effect in favor of thrust manipulation plus exercise compared to an exercise regimen alone for a reduction in pain and disability.
  • Of the 25 studies (that evaluated adverse events), either no or minor events occurred.
  • According to the published trials reviewed, manipulation and mobilization appear safe.

Coulter ID et al. Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician. 2019 Mar;22(2):E55-E70.

Rotator Cuff

A JMPT study found that thoracic SMT Increases Subacromial Space & ROM: “Active shoulder flexion and abduction mobility increase after manipulation of thoracic spine in [rotator cuff] patients. Subacromial space increases significantly…after manipulation.”

Belón-Perez, Pedro et al. Immediate Effects of Thoracic Spine Manipulation Upon Shoulder Functionality in Patients With Sutured Rotator Cuff Repair: A Prospective Study Journal of Manipulative & Physiological Therapeutics , Volume 41, Issue 7, 589 – 595

Lumbar Stenosis

A JAMA randomized clinical trial of 259 lumbar spine stenosis patients compared the effectiveness of three non-surgical options:

  • Medical care consisted of medications and/or epidural injections provided by a physiatrist.
  • Group exercise classes were supervised by fitness instructors in senior community centers.
  • Manual therapy/individualized exercise consisted of spinal mobilization, stretches, and strength training provided by chiropractors and physical therapists.

The results: “…manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises…”

Schneider MJ, Ammendolia C, Murphy DR, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open.2019;2(1):e186828.

Safety of Lumbar Spine Manipulation

A study in the European Spine Journal found: “…no evidence of excess risk for acute lumbar disc herniation with early surgery associated with chiropractic compared with primary medical care.

Hincapié, C.A., Tomlinson, G.A., Côté, P. et al. Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study. Eur Spine J (2018) 27: 1526.

Mechanism of Manipulation

A Spine Journal study was “…the first to measure facet gapping during cervical manipulation on live humans.” The results demonstrate that:

  • Target and adjacent motion segments undergo facet joint gapping (0.9 mm ± 0.4mm) during manipulation.
  • Intervertebral range of motion is increased (8-13 degrees) in all three planes of motion after manipulation.
  • Pain score improved from 3.7±1.2 before manipulation to 2.0±1.4 after manipulation.

Anderst WJ et al. Intervertebral Kinematics of the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation. The Spine Journal Volume 18, Issue 12, December 2018, Pages 2333-2342

Cervicogenic Headache

A Spine Journal study found that in patients suffering from cervicogenic headache, spinal manipulation cuts the number of symptomatic days in half:

“256 adults with chronic cervicogenic headache (CGH) were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions. Participants were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned. A linear dose-response was observed for all follow-ups, a reduction of approximately 1 CGH day/month for each additional 6 SMT visits. Cervicogenic headache days/month were reduced from about 16 to 8 for the highest and most effective dose of 18 SMT visits.”

Haas M. et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J. 2018 Oct;18(10):1741-1754

Muscle Strength

A European study demonstrated that a single session of spinal manipulation increased muscle strength (MVC) and corticospinal excitability in elite athletes. “[Following manipulation,] the increased MVC force lasted for 30 min and the cortical drive increase persisted for at least 60 min.”

Christiansen, T.L., Niazi, I.K., Holt, K. et al. The effects of a single session of spinal manipulation on strength and cortical drive in athletes. Eur J Appl Physiol (2018).

Cervicogenic Headache

Cervical spine mobilization improves range of motion and induces “…immediate headache relief” in patients with cervicogenic headache.

Malo-Urriés, Miguel et al. Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial. Journal of Manipulative & Physiological Therapeutics, Volume 40, Issue 9, 649 – 658

Chiropractic physicians are uniquely suited to deliver evidence-based management for a range of problems from head to toe. Our professional future will depend upon our ability to adapt to and deliver continually emerging best practices, and integrate into developing healthcare models. Regardless of what the details of our practices will look like, our future is bright!

1. Italics added for emphasis.

About Author

Tim Bertelsman, DC, DACO

Dr. Bertelsman graduated from Logan College of Chiropractic with honors in 1991 and has been running a large successful multi disciplinary practice in Belleville, IL for over 20 years. He is an expert on establishing relationships within the medical community.He has lectured nationally for many years on clinical and business topics and has been published extensively. He has served in various leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board. Dr. Bertelsman is a Co-founder of ChiroUp.


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