Can Spinal Manipulative Therapy Be Effective Beyond Muscle and Joint Pain? New Systematic Review

For some years now, the Australian Spinal Research Foundation has been interested in research examining how the brain and nervous system responds when you remove subluxations. In many ways, this is the simplest of causes and yet somehow it is incredibly bold. Research has revealed many exciting possibilities tied up with chiropractic care. Still, debate rages inside and outside the chiropractic profession as to whether chiropractic is more than back and neck pain and the only thing that will put this question to bed for good is further research.

To this end, a new study has appeared in the Asia Pacific Chiropractic Journal. Authored by Carrie-Ann McDowell, the systematic narrative review investigates the question of spinal manipulation’s validity beyond joint and muscle pain.

In undertaking such a task, McDowell was wading into deep waters in terms of quantity, quality and bias. Chiropractic care is a highly individualised form of care which presents some challenges in terms of designing randomised controlled trials. While these challenges are not insurmountable, they are tricky as chiropractic adjustments are delivered by skilled and trained professionals who know what they are looking for and who adjust people according to the needs highlighted during examination. This can make certain types of studies difficult to design. However, much research has been done.

Original searches yielded 1,294 records to be screened for inclusion in the McDowell review. Following the application of exclusion criteria, 23 records remained: ten randomised controlled trials, three surveys, one cohort study and nine systematic reviews. As systematic reviews tend to take in multiple studies, these are a particular area of interest. McDowell reported three systematic reviews that provided evidence for chiropractic. Among the conditions covered in the reviews were: asthma, chronic vertigo, infant colic, children with ear infections, pneumonia in elderly people, among others.  She noted that “Hawk et al concluded that an average of 10.3% of patient visits to chiropractors were for NMSK [non-musculoskeletal] conditions [1].” Furthermore, she noted “an emerging trend towards NMSK research.”


However, many papers in these reviews were inconclusive and highlighted further research needs in their conclusions.

Moving on to the surveys, a golden number of 10% turned up again when discussing chiropractic adjustments for NMSK conditions. While some of the surveys included in the study turned up far higher numbers in terms of NMSK conditions, there was an increased risk of bias highlighted by McDowell in the study.

McDowell’s findings can be best summarised as the following:

  • An average of 10% of patients received care for non-musculoskeletal conditions from chiropractors.
  • There is a large quantity of evidence for spinal manipulative therapy beyond musculoskeletal pain, but we need to continue on the hunt for higher quality evidence as the risk of bias or the need for further, more conclusive research still remains.
  • We need strong evidence for spinal manipulative therapy in order to maintain professional credibility.
  • Chiropractic has a remarkable safety record, low risk of harm and is regarded as safe. The study cited statistics stating, “In Australia, medical error results in as many as 18,000 unnecessary deaths, and more than 50,000 patients become disabled each year [1].” This provides a striking contrast to the low number of adverse events noted in chiropractic research.
  • There is more work to be done, but there appears to be a trend towards non-musculoskeletal research.

The full paper is available at the reference below, and it is certainly well worth a read. WE know that many chiropractic users have reported benefits beyond musculoskeletal pain alone. While capturing and documenting this in a high-quality way remains a challenge and an opportunity for researchers and research organisations alike, it is still an enlightening study which shows the work that has been done and the work still yet to do.

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McDowall C-A. Evidence that may support the claim that spinal manipulative therapy can affect the patient beyond muscle and joint pain: A systematic narrative review. Asia-Pac Chiropr J. 2021;1.3.URL



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