First of all I will confess that I devoted several years of my physiotherapy career to learning and “mastering” spinal manipulative therapy (SMT). Early on in my 33 year career, I truly believed that once I knew how to do manips, then I’d finally be an amazing physio. So I kept taking various manual therapy courses, did my masters in manips and even my doctorate on it. I practiced it for several years until about 20 years ago I reached the conclusion that this latest systematic review has concluded in 2025!
“Differences between SMT approaches appear small and likely not clinically relevant.” – Nim et al 2025
This means that after decades of research and 161 RCTs involving over 11,000 patients, spinal manips are not superior to any other intervention.
“The highest probability of providing the greatest average treatment effects for reducing pain and disability was observed for “more general and nonspecific” SMT application.” – Nim et al 2025
This means that the evidence thus far, contradicts all those PTs, Chiros ad osteopaths who claim that “specificity” of manipulation is the key to success!
“Our results emphasize that attempting to identify the correct thrust at the correct site and testing to determine these are unnecessary” – Nim et al 2025
I recall being criticized by some that my teaching of “general” spinal manipulation was wrong and that I should not be doing it. It turns out that the “general” manips are potentially MORE effective than the so called specific manips.
Honestly, for the past decade I rarely practice SMT as I just don’t think it’s needed.