The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: myth or reality? A systematic review

Review written by Dr Sandy Hilton info

Key Points

  1. Practice guidelines include spinal manipulative therapy (SMT) as a treatment option for spinal pain.
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BACKGROUND & OBJECTIVE

Clinical practice guidelines continue to recommend spinal manipulative therapy (SMT) as an option for treating spinal pain (1). Clinicians are encouraged in employment, advertisements, and courses to pursue specific training in manual techniques to improve clinical outcomes. SMT is taught as a skilled procedure that emphasizes careful selection of site and movement of the selected segment.

Claims have been made that the application of precise force at a correctly located, specific level will result in specific changes in mobility. If this is true, then there should be a different outcome between SMT to a target segment compared to any other spinal location.

The authors of this systematic review compared spine-related outcomes when SMT is applied to a specific site thought to be clinically relevant, versus when SMT is applied to any other spinal location.

Clinical practice guidelines continue to recommend spinal manipulative therapy as an option for treating spinal pain.
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SMT given at a clinician-determined “correct” vertebral level was no different than SMT at no specific level.

METHODS

  • Systematic review using the Cochrane risk of bias tool.
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