Spinal manipulation has a solid evidence base for musculoskeletal pain: our articles on manipulation for low back pain and the best treatments for low back pain cover that research directly. The evidence looks very different once you move outside pain and mobility conditions and into the theory that manipulating the spine can influence internal organs and systems elsewhere in the body.
What the Research Found
Some practitioners, mostly a small share of chiropractors and osteopaths, use spinal manipulation to treat conditions with no direct connection to the spine or nervous system: infantile colic, childhood asthma, high blood pressure, painful periods, and migraine. The reasoning behind this is a theory that spinal dysfunction disrupts nerve signaling to distant organs, and that correcting it restores normal function elsewhere in the body.
In 2021, a group of 50 researchers from 8 countries convened a Global Summit, with 28 additional observers from 18 chiropractic organizations, to review the evidence for that theory. Côté and colleagues published the results in Chiropractic & Manual Therapies. The team screened 32 studies and included 16 in their systematic review, six of them randomized controlled trials of acceptable or high quality, covering 534 patients in total.
Across all six trials, spinal manipulation performed no better than sham manipulation for any of the five conditions studied: colic, asthma, hypertension, dysmenorrhea, and migraine. The authors concluded that this evidence challenges the underlying theory itself, not just its application to these five conditions specifically.
This review came out of the chiropractic profession itself, not from physical therapy or from critics of manual therapy generally. The summit’s own researchers reached this conclusion after examining their own field’s evidence.
How We Apply This at Mend
We use spinal manipulation the way the evidence supports it: as a short-term tool for musculoskeletal pain, paired with exercise, not as a treatment aimed at organs or systems elsewhere in the body. If you’re seeing a provider who recommends manipulation for a condition unrelated to pain or joint mobility, this research is worth bringing up in that conversation.
You can find more of our manipulation research in our manual therapy library and back and spine library.
If you’re dealing with neck, back, or joint pain and want treatment grounded in what the research actually supports, schedule an appointment at our Boulder or Lafayette clinic.
