Top Chiropractic Research from 2024: Elevating Evidence-Based Care
As chiropractors, we’re fortunate to work in a field supported by an ever-growing body of chiro research that supports our profession. At times, however, it can feel overwhelming to sift through the enormous number of chiropractic studies to find actionable insights. That's why your team at ChiroUp has curated the top chiropractic research studies from 2024, providing not only a recap of groundbreaking findings but also practical tools to integrate them into your practice.
This blog distills key findings and themes from this year’s chiropractic studies, spotlighting the benefits of spinal manipulative therapy (SMT) and other chiropractic interventions. From reducing opioid dependence to improving functional outcomes, these chiropractic studies affirm our role as leaders in musculoskeletal health.
1. Chiropractic Utilization Continues to Rise
A pivotal study analyzing U.S. trends from 2007 to 2016 showed a significant increase in chiropractic utilization, reinforcing the growing trust in chiropractic care.
“The findings showed statistically significant increasing trends for the number of adult chiropractic users, the number of visits, and percent utilization of chiropractic care.” (1) Chen et al. JMPT. Sept 2024 Link
Deeper Dive: As chiropractic utilization continues to rise nationwide, success stories like Thigpen Chiropractic highlight the tangible benefits of embracing innovative tools and strategies. Their 200% increase in Google reviews and 90% patient app engagement showcase how leveraging technology and patient-focused care can drive growth and elevate the profession. Explore the full 2024 case study here to see how these strategies can amplify your practice as the demand for chiropractic care grows.
2. SMT and Cervical Artery Dissection: Debunking Myths
This year, multiple studies reaffirmed that cervical spine manipulation (CSM) is not causally linked to cervical artery dissection (CAD).
"In all cases, causation of CAD by CSM was not supported by the evidence. [There was] no convincing evidence of the causation of cervical artery dissection by cervical spine manipulation in a healthy cervical spine." (2) Brown et al. Journal of Forensic and Legal Medicine. Oct 2024 Link
In a related study, researchers found that passive neck ROM testing produced vertebral artery strains 3-7 times greater than those caused by HVLA spinal manipulation.
“Strains in the vertebral artery during chiropractic spinal manipulation were much smaller than the strains that can occur during normal everyday movements of the head and neck.” (3) Fagundes et al. Journal of Bodywork and Movement Therapies. Oct 2024 Link
Deeper Dive: There is abundant data to refute SMT as a cause of stroke. Download our Chiropractic Safety Toolkit for additional patient and provider resources, including a sharable infographic and a link to our top chiropractic webinar ever!
Our Vote for the Worst Paper of the Year: Perpetuating Chiropractic Safety Misconceptions
"Chiropractic cervical spinal manipulations have several complications and can result in vascular injury, including traumatic dissection of the vertebral arteries. This case presents a unique circumstance of a fatal vertebral artery dissection after self-chiropractic manipulation." (4) Fink et al. The American Journal of Forensic Medicine and Pathology. June 2024 Link
This paper highlights a troubling misuse of terminology and reinforces persistent misconceptions about chiropractic care. First and foremost, self-manipulation is not chiropractic care. Chiropractic spinal manipulation is performed by highly trained, licensed professionals—not lay individuals acting on themselves. Mislabeling such tragic cases contributes to misinformation that unfairly raises concerns about chiropractic safety.
The report also highlights a broader issue that persists in some areas of medical literature: conflating correlation with causation. Many high-quality studies have demonstrated that cervical spinal manipulation, when performed by qualified chiropractors, is not a proven cause of vascular events like cervical artery dissection. (5,23-28) Unfortunately, claims of causation often arise from poorly designed case reports and retrospective studies; a fact reinforced by the Annals of Medicine:
The assumption that the cervical manual-therapy intervention triggers CAD in rare cases has been dominated by single-case reports and retrospective case series or surveys from neurologists who naturally lack substantial methodological quality to establish definitive causality. These neurological case reports have probably contributed to an over-reporting of serious and catastrophic adverse events.” (5) Chaibi et al. Annals of medicine. Feb 2019 Link
When case reports like this misrepresent facts, they create unnecessary fear, perpetuate distrust, and discourage patients and providers from seeking safe, evidence-based care.
Tip: As healthcare providers, we must work together to share accurate, evidence-based information about chiropractic safety. Resources like the ChirpoUp Safety of Cervical Manipulation can help clarify misconceptions and foster collaboration within the healthcare community.
3. Cauda Equina Syndrome and Spinal Manipulation: Also No Causal Link
Similar to stroke cases, there is also a correlation where patients developing cauda equina syndrome (CES) often seek chiropractic care; however, manipulation is not the causative factor. In fact, a 2024 study of 67,220 patients found that CES rates following chiropractic spinal manipulation were even lower than those observed after traditional physical therapy without manipulation.
“CES [cauda equine syndrome] incidence was 0.07% in the CSM [chiropractic spinal manipulation] cohort compared to 0.11% in the PT [physical therapy] evaluation cohort. These findings suggest that CSM [chiropractic spinal manipulation] is not a risk factor for CES [cauda equine syndrome].” (6) Trager et al. Plos one. Mar 2024 Link
4. Replacing Opioids with Chiropractic Care
Multiple high-quality studies have shown that conservative manual therapy reduces the rate of opioid utilization, including this paper:
"The use of manual therapy along with active interventions was associated with reduced prescription of opioids." (7) Mayer et al. Physical Therapy. July 2024 Link
However, a Medicare study found chiropractic utilization was notably lower among patients with opioid use disorder (OUD), underscoring the need for equitable access to conservative care.
"People with OUD were more likely to belong in trajectories with little/no PT or chiropractic care as compared to other trajectories. The findings indicate that people with co-occurring chronic pain and OUD often do not receive early or any nonpharmacologic pain therapies as recommended by practice guidelines…targeted interventions (eg, insurance policy, provider, and patient education) are needed to ensure equitable access to guideline-recommended pain therapies." (8) Moyoet al. The Journal of Pain. Mar 2024 Link
A related study by the same authors on acute LBP found that Medicare beneficiaries with OUD were 38% less likely to receive nonpharmacologic therapies, such as chiropractic care, and were more than twice as likely to receive prescription opioids and co-prescriptions of gabapentin compared to those without OUD. (9) Moyo et al. Journal of General Internal Medicine. Jun 2024 Link
Resource: Nonpharmacologic approaches, including chiropractic care, are now firmly established as first-line treatments for chronic LBP, but we need to spread the word. Download and share the Opioid Crisis whitepaper highlighting how chiropractic is a valuable weapon in the ongoing opioid epidemic.
5. Fifty Years of Evidence: Clinical Guidelines Strongly Endorse SMT
An extensive review of 33 clinical practice guidelines spanning 50 years found substantial support for spinal manipulative therapy (SMT):
“The recommendations primarily targeted low back pain and neck pain; of these, 90% favored SMT for low back pain while 100% favored SMT for neck pain. Recent CPG [clinical practice guidelines] recommendations favored SMT for tension-type and cervicogenic headaches. …These findings reinforce the utility of SMT for spine-related disorders.” (10) Trager et al. Journal of Clinical Medicine. Sept 2024 Link
Deeper Dive: SMT is endorsed by multiple authoritative clinical practice guidelines. Spread the word with ChiroUp’s Natural Solution toolkit, including a potent video, newsletter, and infographic.
6. Chiropractic Care Saves Costs and Reduces Healthcare Utilization
A study of healthcare utilization patterns confirmed that patients who saw chiropractors as their initial providers incurred fewer costs and avoided invasive procedures.
"Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management. " (11) Farabaugh et al. Chiropractic & Manual Therapies. Mar 2024 Link
This concurs with another study from last year:
"The use of physical therapists and chiropractors as entry points into the health system appears related to a decrease in immediate and long-term use of health resources. This study expands the existing body of literature and provides a compelling case for the influence of the first provider on an acute episode of LBP." (12) Bise et al. Physical Therapy. Sept 2023 Link
Deeper Dive: ChiroUp subscribers can access and share the Healthcare Affordability Infographic, featuring compelling data that highlights chiropractic care as a highly cost-effective solution. Simply search "affordability" in your Forms Library to download and start using it today!
7. Neural Mobilization: A Rising Star in Conservative Pain Management
Neural mobilization continued to emerge as a standout technique for improving outcomes in patients with conditions like sciatica and carpal tunnel syndrome.
In patients with tennis elbow, “Neural mobilization demonstrated the most substantial increase in range of motion (ROM). Consequently, incorporating neural mobilization into the treatment plan.” (13) Jain et al. Journal of Bodywork and Movement Therapies. Apr 2024 Link
In patients with peripheral neuropathic pain, “Neural mobilisation seems to improve (i.e., a reduced) the cross-sectional area and sensory conduction velocity.” (14 ) Bittencourt et al. PloS one. Nov 2024. Link
"Therapy accompanied by neural mobilization is superior for improving mobility in comparison with routine physical therapy alone in patients with musculoskeletal neck disorders and cervical radiculopathy." (15) López-Pardo et al. InHealthcare Jan 2024 Link
The Journal of Clinical Medicine also concluded that neural mobilization yields moderate evidence of effectiveness for managing lumbar disc herniation associated with radiculopathy. (16) El Melhat et al. Journal of Clinical Medicine. Feb 2024 Link
And a couple of bonuses from late last year:
In patients with lumbar radiculopathy, "Neural mobilization yielded a significant reduction in pain intensity [...and] significantly alleviated disability." (17) Lin et al. Life. Nov 2023 Link
"Neural mobilisation as part of multimodal interventions appears to have a positive effect on pain for patients with low back pain and neck pain and on function in people with low back pain." (18) Baptista et al. Clinical Rehabilitation. Nov 2023 Link
Deeper Dive: Is nerve mobilization part of your toolbox? Check out the top chiropractic blog on Neurodynamics for detailed tutorials:
8. Lumbar Disc Herniations: Why Conservative Care Wins
A 2024 review confirmed that spinal manipulation is an effective conservative treatment for lumbar disc herniation with radiculopathy. Alongside other interventions like patient education, exercise therapy, McKenzie method, and neural mobilization, manipulation demonstrated moderate evidence for reducing pain and disability. (16) El Melhat et al. Journal of Clinical Medicine. Feb 2024 Link
Other studies concurred:
"In the absence of cauda equina syndrome, motor, or other serious neurologic deficits, conservative treatment should be the first line of treatment for LDH [lumbar disc herniations].” (19) Yaman et al. World Neurosurgery: Feb 2024 Link
SMT was also shown to reduce lumbar spine reoperation rates in patients with lumbosacral radiculopathy following discectomy. In fact, patients receiving SMT were 45% less likely to require reoperation compared to those receiving usual care. (20) Trager et al. BMC Musculoskeletal Disorders. Jan 2024 Link
Deeper Dive: Watch the ChiroUp Masterclass on Disc Lesions and Degeneration for some valuable clinical pearls on this common yet potentially challenging diagnosis.
In case you’re counting, this is the third paper in our 2024 chiropractic research countdown with Robert Treger DC as the primary author! Thank you 🤩 #ResearchRockStar
9. Imaging vs. Symptoms: What Really Matters in Pain Diagnosis
Like prior years, 2024 saw additional data that refutes a direct correlation between spinal degeneration and pain.
"There was no significant association between the clinical symptoms of pain and disability and the MRI findings for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration.” (21) Norisyam et al. Cureus. Dec 2023 Link
Deeper Dive: Subscribers can share the news with these ChiroUp infographics. Search the Forms Library for “Imaging” or “Pain & Dysfunction”.
10. Ice or Heat? Choosing the Right Therapy at the Right Time
Cryotherapy and thermotherapy are valuable tools in managing injuries, but their application depends on the stage and type of condition being treated.
"Cryotherapy may be recommended in the first 6 hours following an injury to reduce pain (and possibly haematoma), but it should be used with caution beyond 12 hours postinjury as animal studies suggest it may interfere with tissue healing and regeneration." (22) Racinais et al. British Journal of Sports Medicine. Sep Link
Deeper Dive: Review the recent Heat vs Cold blog with 38 references to help guide your decisions, or check out the Mic’d Up with ChiroUp podcast on choosing Ice vs Heat. And while you’re there, be sure to subscribe so you don’t miss a single episode of the top chiropractic podcast.
Conclusion
Chiropractic and research are becoming progressively more aligned. Our care continues to be validated as a safe, effective, and cost-efficient approach to managing musculoskeletal conditions. This year’s research not only strengthens the evidence for our interventions but also provides a roadmap to better outcomes and greater professional recognition.
Keeping up with the rapid pace of new evidence can be challenging—but ChiroUp makes it simple. Our curated Research Review Feed (updated weekly) distills groundbreaking advancements into actionable insights you can seamlessly integrate into your care plans, helping you deliver better results and elevate chiropractic’s standing as a trusted healthcare solution.
If you’re already a ChiroUp user, explore the latest research updates HERE.
Not yet a member? Step into the future of chiropractic care alongside 3,000+ like-minded chiropractors who are shaping the profession’s next chapter. Together, we’re making chiropractic care more impactful, more rewarding, and the undeniable best choice for patients and payors alike.
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1. Chen B, Brown HS, Douphrate D, Janak J, Gabriel KP, Peng T. National Trends in the Utilization and Expenditure of Chiropractic Care in US Adults: Analysis of the 2007-2016 Medical Expenditure Panel Survey. Journal of Manipulative and Physiological Therapeutics. 2024 Sep 27. Link
2. Brown S. Review of nine malpractice cases with allegations of causation of cervical artery dissection by cervical spine manipulation: No evidence for causation. Journal of Forensic and Legal Medicine. 2024 Oct 22:102783. Link
3. Fagundes C, Herzog W. Strain of the vertebral artery during passive neck movements and spinal manipulation of the cervical spine: An observational study. Journal of Bodywork and Movement Therapies. 2024 Oct 1;40:569-74. Link
4. Fink C, Bryce CH, Knight LD. Self-chiropractic cervical spinal manipulation resulting in fatal vertebral artery dissection: a case report and review of the literature. The American Journal of Forensic Medicine and Pathology. 2024 June:10-97. Link
5. Chaibi A, Russell MB. A risk–benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Annals of medicine. 2019 Feb 17;51(2):118-27. Link
6. Trager RJ, Baumann AN, Perez JA, Dusek JA, Perfecto RP, Goertz CM. Association between chiropractic spinal manipulation and cauda equina syndrome in adults with low back pain: Retrospective cohort study of US academic health centers. Plos one. 2024 Mar 11;19(3):e0299159. Link
7. Mayer JM, Highsmith MJ, Maikos J, Patterson CG, Kakyomya J, Smith B, Shenoy N, Dearth CL, Farrokhi S. The Influence of Active, Passive, and Manual Therapy Interventions on Escalation of Health Care Events After Physical Therapist Care in Veterans With Low Back Pain. Physical Therapy. 2024 Jul 20:pzae101. Link
8. Moyo P, Merlin JS, George M, Shireman TI, Marshall BD. Association of opioid use disorder diagnosis with use of physical therapy and chiropractic care among chronic low back pain patients: a group-based trajectory analysis. The Journal of Pain. 2024 Mar
9. Moyo P, Merlin JS, Gairola R, Girard A, Shireman TI, Trivedi AN, Marshall BD. Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis. Journal of General Internal Medicine. 2024 Jun 3:1-9. Link
10. Trager RJ, Bejarano G, Perfecto RP, Blackwood ER, Goertz CM. Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations. Journal of Clinical Medicine. 2024 Sep 24;13(19):5668. Link
11. Farabaugh R, Hawk C, Taylor D, Daniels C, Noll C, Schneider M, McGowan J, Whalen W, Wilcox R, Sarnat R, Suiter L. Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review. Chiropractic & Manual Therapies. 2024 Mar 6;32(1):8. Link
12. Bise CG, Schneider M, Freburger J, Fitzgerald GK, Switzer G, Smyda G, Peele P, Delitto A. First provider seen for an acute episode of low back pain influences subsequent health care utilization. Physical Therapy. 2023 Sep 1;103(9):pzad067. Link
13. Jain C, Goyal M, Kothiyal S. Efficacy of neural mobilization and Maitland accessory mobilization in patients with tennis elbow-randomized controlled trial. Journal of Bodywork and Movement Therapies. 2024 Apr 1;38:525-33. Link
14. Bittencourt JV, Corrêa LA, Pagnez MA, do Rio JP, Telles GF, Mathieson S, Nogueira LA. Neural mobilisation effects in nerve function and nerve structure of patients with peripheral neuropathic pain: A systematic review with meta-analysis. PloS one. 2024 Nov 8;19(11):e0313025. Link
15. López-Pardo MJ, Calvache-Mateo A, Martín-Núñez J, Heredia-Ciuró A, López-López L, Valenza MC, Cabrera-Martos I. Routine Physical Therapy with and without Neural Mobilization in Chronic Musculoskeletal Neck Disorders with Nerve-Related Symptoms: Systematic Review and Meta-Analysis. InHealthcare 2024 Jan (Vol. 12, No. 12, p. 1225). Multidisciplinary Digital Publishing Institute. Link
16. El Melhat AM, Youssef AS, Zebdawi MR, Hafez MA, Khalil LH, Harrison DE. Non-surgical approaches to the management of lumbar disc herniation associated with radiculopathy: A narrative review. Journal of Clinical Medicine. 2024 Feb 8;13(4):974. Link
17. Lin LH, Lin TY, Chang KV, Wu WT, Özçakar L. Neural Mobilization for Reducing Pain and Disability in Patients with Lumbar Radiculopathy: A Systematic Review and Meta-Analysis. Life. 2023 Nov 26;13(12):2255. Link
18. Baptista FM, Nery E, Cruz EB, Afreixo V, Silva AG. Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain–A Systematic Review with Meta-Analysis. Clinical Rehabilitation. 2023 Nov 21:02692155231215216. Link
19. Yaman O, Guchkha A, Vaishya S, Zileli M, Zygourakis C, Oertel J. The role of conservative treatment in lumbar disc herniations: WFNS spine committee recommendations. World Neurosurgery: X. 2024 Feb 13:100277. Link
20. Trager RJ, Gliedt JA, Labak CM, Daniels CJ, Dusek JA. Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study. BMC Musculoskeletal Disorders. 2024 Jan 10;25(1):46. Link
21. Norisyam Y, Salim AA, Bahrin Z, Yusof MI, Paiman M, Nadarajan C, Salim AA, Yusof MI. Lateral Lumbar Spinal Stenosis: Associations With the Oswestry Disability Index, Visual Analogue Scale, and Magnetic Resonance Imaging. Cureus. 2023 Dec 13;15(12). Link
22. Racinais S, Dablainville V, Rousse Y, Ihsan M, Grant ME, Schobersberger W, Budgett R, Engebretsen L. Cryotherapy for treating soft tissue injuries in sport medicine: a critical review. British Journal of Sports Medicine. 2024 Sep 4. Link
23. Kosloff TM, Elto D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case–control study in U.S. commercial and Medicare Advantage populations. Chiropractic & Manual Therapies (2015) 23:19 Link
24. Cassidy JD et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population based case-control and case-crossover study. Spine 2008 Feb 15;33(4 Suppl):S176-83 Link
25. Cassidy, J. David et al. Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study. Journal of Stroke and Cerebrovascular Diseases, Volume 26, Issue 4 , 842 – 850 Link
26. Whedon JM, Petersen CL, Li Z, Schoelkopf WJ, Haldeman S, MacKenzie TA, Lurie JD. Association between cervical artery dissection and spinal manipulative therapy–a medicare claims analysis. BMC Geriatrics. 2022 Dec;22(1):1-9. Link
27. Whedon JM, Petersen CL, Schoellkopf WJ, Haldeman S, MacKenzie TA, Lurie JD. The association between cervical artery dissection and spinal manipulation among US adults. European Spine Journal. 2023 Jul 8:1-8. Link
28. Whedon JM, et al. Risk of Traumatic Injury Associated With Chiropractic Spinal Manipulation in Medicare Beneficiaries Aged 66 to 99 Years. Spine 2015;40:264–270 Link
