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There are many discrepancies when describing the mechanics, benefits, and risks of spinal manipulative therapy (SMT). Chiropractic literature has a plethora of viewpoints regarding SMT, leaving too much room for other professions, personal opinions, and publications to define our primary tool. New studies are published monthly, outlining the BENEFITS of spinal manipulation. And it is our duty as evidence-based chiropractors to relay these facts for the advancement of our profession and the health of our patients.

Evidence-based chiropractors study new research with the intent to be empowered. So, this blog reviews some of the most significant studies from 2019 that you can use to relay the facts about SMT.


In years past, SMT critics pointed to a lack of data regarding effectiveness. Now that overwhelming evidence proves efficacy, critics have drawn attention to safety concerns. Fortunately, new research continues to support the safety of SMT:

1. Annals of Medicine: “Manual therapy does not result in an increased risk of cervical artery dissection.” (1)

2. There is no increased risk of stroke after spinal manipulation (SMT) of the cervical spine. SMT only produces a fraction of the force needed to tear the wall of a healthy artery. In fact, “strains for the cervical manipulation trials are typically less than 50% of those obtained during normal ROM testing.” (2) 


Joint cavitation is one of the key features of HVLA and is considered by most patients and many providers to be crucial for the effective delivery of this technique. i.e., “Did it go doc? I didn’t hear anything that time.” Here are some new facts:

1. Manipulation results in facet joint separation and resultant cavitation; distractive forces are not specific to a particular segment. Manipulation improves range of motion (8-13 degrees in the cervical spine) and results in local pain relief (3)

2. Cavitation is “significantly more likely to occur unilaterally, and on the side contralateral to the short-lever applicator contact during cervicothoracic HVLA thrust manipulation.” (4)


2019 has seen dozens of impactful studies regarding the benefits of SMT. Here are two great ones:

1. 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. They concluded: “We observed that spinal manipulation reduced migraine days as well as migraine pain intensity.” (5)

2. A BMJ study encompassing nearly a quarter-million LBP patients compared initial and long-term opioid use with choice of initial provider. The study concluded: “Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians.” Drilling beyond the abstract, the data demonstrated that between PT’s and DC’s, chiropractic patients had significantly lower initial and long-term opioid use (0.10 vs. 0.15). (6)

Use the ChiroUp Opioid infographic to spread the news about how chiropractic care is part of the solution to the opioid crisis.

We created ChiroUp to change interprofessional and public opinion concerning chiropractic and spinal manipulation. If you need references to support the application of manipulation per diagnosis, then check out the ChiroUp CONDITION REFERENCE SECTION. You’ll be able to review up-to-date management recipes for the top 100 musculoskeletal conditions. Our team works diligently to scour the literature to provide these continually-updated resources for your practice.

We don’t speak for you, but we expect to hear from you. If you get your feelings hurt or experience a visceral response to something you hear about manipulation, congratulations—You care. I caution listening, watching, or talking about things you already know – it may not be the best use of your time. In 2020, I challenge you to take a risk and look at the other side of any argument.

Evidence-based DC’s build their opinions on available unbiased research and continually invite new information. Days that we are proven wrong should be our favorite days in practice. It’s because we know that we have learned something and grown.

So now, let me ask you: what new clinical tools will you add to your toolbox this year? 

ChiroUp makes your commitment to staying on top of the latest research easy with our condition references. Learn more about that resource here & how you can get started with the #1 online chiropractic resource today — We want to be on your team this year!

  1. 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. 
  2. Symons B, Herzog W. Cervical artery dissection: a biomechanical perspective. The Journal of the Canadian Chiropractic Association. 2013 Dec;57(4):276.
    1. 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 
    2. Dunning J, Mourad F, Zingoni A, et al. Cavitation Sounds During Cervicothoracic Spinal Manipulation. International Journal of Sports Physical Therapy. 2017;12(4):642-654.
      1. 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. 
      2. Kazis LE, Ameli O, Rothendler J, et al. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open 2019;9:e028633. doi: 10.1136/bmjopen-2018-028633.

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