12/08/2025
Low back pain is one of the most common reasons patients seek care, and one of the most researched areas in conservative musculoskeletal management.
Several major systematic reviews and clinical guidelines highlight why spinal manipulation is recommended as a first-line option:
1. JAMA Systematic Review – Acute Low Back Pain
A comprehensive review published in JAMA analyzed 26 randomized controlled trials and found that spinal manipulation led to statistically significant improvements in both pain and function compared to sham or usual medical care. Benefits were most notable in the first six weeks, where early mobility and pain reduction are crucial for preventing chronicity.
2. BMJ Review – Chronic Low Back Pain
A large BMJ meta-analysis examining chronic low back pain found that spinal manipulation produced outcomes comparable to recommended non-pharmacologic treatments such as exercise therapy and physical therapy. Patients experienced improvements in mobility, pain, and overall function. Importantly, spinal manipulation showed these benefits without exposure to medications, injections, or surgical risks.
3. American College of Physicians Guidelines
The American College of Physicians (ACP), one of the most respected medical bodies in the world, includes spinal manipulation as a recommended non-drug treatment for both acute and persistent low back pain.
The ACP guidelines emphasize using spinal manipulation before escalating to more invasive approaches such as opioid medications, spinal injections, or surgery.
4. International Guidelines Agree
Clinical guidelines from Europe, Canada, and the United Kingdom similarly list spinal manipulation as a proven option for mechanical low back pain, citing consistent improvement in pain, function, and patient satisfaction when used appropriately.
What This Means for Patients
Across multiple studies and guideline groups, the evidence is clear:
Spinal manipulation is an effective, research-supported treatment for mechanical low back pain and should be part of early conservative care.
Stine Chiropractic Clinic
Evidence-Based Chiropractic Orthopedic Care
stinechiro.com • 540-898-4100