[3] A 2010 systematic review found that most studies suggest SM achieves equal or superior improvement in pain and function compared with other commonly used interventions for short-, intermediate-, and long-term follow-up.
[12] A 2015 Cochrane systematic review found that there is no high-quality evidence assessing the effectiveness of spinal manipulation for treating neck pain.
[15] Historically, some within the chiropractic profession have claimed that spinal adjustments have physiological effects on visceral functions and thus affect overall health beyond musculoskeletal conditions.
Over time, this hypothesis is inconsistent with our modern understanding of pathology and disease, and only "a small proportion of chiropractors, osteopaths, and other manual medicine providers use[ing] spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders.
"[16] A 2019 global summit of "50 researchers from 8 countries and 28 observers from 18 chiropractic organizations" conducted a systematic review of the literature, and 44 of the 50 "found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine.
"[16] As for manipulation with the assistance of medication or anesthesia, a 2013 review concludes that the best evidence lacks coherence to support its use for chronic spine pain.
[18][13][19] Spinal manipulation is frequently associated with mild to moderate temporary adverse effects, and also rare serious outcomes which can result in permanent disability or death.
[19][20][13][21] The National Health Service in the UK notes that about half of people reported encountering adverse effects following spinal manipulation.
[21] Adverse events are increasingly reported in randomized clinical trials of spinal manipulation but remain under-reported despite recommendations in the 2010 CONSORT guidelines.
[34] A 2007 systematic-review found correlations of mild to moderate adverse effects and less frequently with cervical artery dissection, with unknown incidence.
[19] A 2016 systematic-review found the data supporting a correlation between neck manipulation and cervical artery dissection to be very weak and that there was no convincing evidence for causation.
[35] A 2024 narrative review noted the thromboembolic and thrombotic mechanisms of causation of immediate stroke after cervical spine manipulation that are in the existing peer-reviewed literature.
Such reporting adversely affects the reader's opinion of chiropractic and chiropractors.This error was taken into account in a 1999 review[40] of the scientific literature on the risks and benefits of manipulation of the cervical spine (MCS).
Special care was taken, whenever possible, to correctly identify all the professions involved, as well as the type of manipulation responsible for any injuries and/or deaths.
"[40] Spinal manipulation is a therapeutic intervention that has roots in folk medicine such as the traditional bone-setting and has been used by various cultures, apparently for thousands of years.
[44] A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of osteopathic and chiropractic medicine.
Because of its distinct segmental biomechanics (see section below), the term high velocity low amplitude (HVLA) thrust is often used interchangeably with manipulation.