The Effects of Spinal Manipulative Therapy on Low Back Pain

Back pain affects 80 percent of the population at some point, making it one of the most common health problems in the world. It typically affects the lower back, although specific episodes vary greatly in their intensity and duration. Some people with low back pain (LBP) find that it goes away on its own after a short time, while others suffer from chronic pain for years. LBP is, therefore, a challenging condition to diagnose and treat.

Spinal manipulative therapy (SMT) is a technique that health care professionals often use to relieve LBP and improve physical functions, especially walking and running. Its use has become more common since the American College of Physicians included SMT as a treatment to consider when LBP fails to respond to self-care in its 2007 guidelines. SMT takes many different forms, depending on the practitioner and specific purpose of the therapy. Numerous studies indicate that SMT may be an effective therapeutic option for LBP.


SMT may be practiced by a range of healthcare professionals, including chiropractors, medical doctors, naturopathic physicians, osteopathic physicians and physical therapists. The goal of the treatment varies, but it’s usually to relieve pain and restore physical functioning. SMT generally involves the practitioner applying a controlled force to a spinal joint with their hands or a device. The amount of force used primarily depends on the specific purpose of the SMT, which may include physical therapy, exercise or massage. Practitioners often administer SMT in conjunction with conventional therapies such as pain-relieving medications, a firm mattress and heat.


Scientific studies generally show that SMT may relieve mild-to-moderate pain due to LBP as effectively as conventional treatments.

A 2008 review found strong evidence that SMT was as effective as a combination of exercise and medical care in relieving chronic LBP. It also found moderate evidence that a combination of SMT and strength exercises were as effective as prescription-strength non-steroidal anti-inflammatory drugs (NAIDS) combined with exercise. Furthermore, this review showed limited evidence that SMT was as effective as a combination of physical therapy and exercise.

A 2009 analysis reviewed 76 studies on conventional and alternative practices for LBP. The researchers in this analysis found that many treatments had minor pain-relieving effects on LBP, including SMT. These effects didn’t depend on whether the patient had acute or chronic LBP.

A 2010 review examined the effects of manual therapies like SMT and massage for a range of conditions. This review found strong evidence that SMT is effective for chronic LBP. It also found moderate evidence that SMT is effective against acute LBP.

A 2011 review analyzed the results from 26 clinical trials regarding the effectiveness of several treatments for LBP. The reviewers concluded that SMT is as effective as other methods of relieving pain and improving function.

Long-term Benefits

Researchers are currently studying the long-term effects of SMT. The National Center for Complementary and Integrative Health (NCCIH) funded one such study involving over 600 patients with LBP. The results indicated that chiropractic care that included SMT was at least as effective as conventional treatments for a period of up to 18 months. However, the study also showed that less than 20 percent of these patients were pain-free after 18 months, regardless of the treatment they received.


SMT is generally safe for the treatment of LBP, provided it’s performed by a trained practitioner. The most common side effect is typically minor discomfort in the treatment area, which usually goes away within two days. Other side effects such as fatigue are also minor in most cases. Serious complications of SMT are very rare.