20/04/2026
Does it actually matter where on the spine you manipulate? According to a 2021 systematic review — Nim et al. — the answer might be no. Not because spinal manipulation doesn’t work. But because the mechanism appears to be far less site-specific than most of us were trained to believe.
Worth noting — the review has limitations. The lack of blinding in spinal manipulation research is a known problem, and most studies used a single intervention rather than a course of treatment. Short study durations and varied clinical presentations also make it harder to draw firm conclusions. The authors acknowledge this. But they also note that even with those limitations, the consistent absence of difference between groups actually strengthens the argument that site specificity is not the primary driver of outcomes.
Make of that what you will.