07/21/2022
I like getting the feeling of getting "adjusted" but....is it doing what they say it will do?
Thoughts?
Pick a joint! ANY joint.
Spinal manipulative therapy (SMT) is the âpoppingâ or wiggling of spinal joints â the staple of nearly all chiropractic and osteopathic therapy (and also utilized by physiotherapists). But a 2021 study shows that it doesnât much matter which joints are manipulated.
Which is not a great look.
THE STUDY: âThe importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review,â Sci Rep, 2021.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8642385
More specifically, the study showed that thereâs no benefit to SMT based on skilled joint selection, which is a nifty angle.
How ELSE would joints be selected? Is there some other kind of joint selection? In theory, all SMT is applied to joints chosen with expertise and skill â especially SMT performed in the context of scientific trials, one would hope. (And yet, ironically, studying only the most mediocre manipulation might actually be more pragmatic: most patients, by definition, can only access average quality care.)
Nim et al. evaluated tests of SMT where adjustment of âclinically relevant jointsâ was compared to SMT applied âelsewhereâ to ânon-candidateâ joints. Obviously the expertly selected joints should have produced better results. But they didnât.
That result was based on data from 10 studies âall of acceptable qualityâ (SMT has been studied quite a bit). Nine of them reported no statistically significant differences. The only paper that did report a difference reported only a small one⊠and had a high risk of bias (which usually leads inexorably to errors in the researchersâ favour).
If it doesnât matter what joint you âadjust,â then it doesnât matter if you adjust joints at all. This data is quite damning to SMT. Obviously.
HOW THIS FITS INTO THE BIGGER SMT PICTURE
These results are not exactly surprising. The body of evidence on this topic has relentlessly shown that, on average, SMT is just as underwhelming an intervention as everything else: minor benefits at best.
There are MANY anecdotes about manipulation being super helpful for at least some patientsâjust the right stimulus at the right time to really make a difference. I believe some of those are true. I have one of my own!
But there are not enough believable anecdotes for them to be anything more than the exception to the rule.
By focusing on joint selection, this study highlights and reinforces existing knowledge in an interesting new way.
Plus, itâs in the freakin' journal Nature! Itâs right there on Nature.com! Right? The ultimate scientific journal! Um⊠well⊠about thatâŠ
CONSIDER THE SOURCE: THE JOURNAL âNATUREâ?
At first glance, this paper might seem to be published in the highly prestigious journal Nature, because of the domain itâs on â which is exactly how it was originally presented to me by a reader.
But no! Itâs from the same publisher, but this is Scientific Reports ⊠which is about as different as it could possibly be.
SR is an open-access mega-journal, the largest scientific journal in the world by article count, with a business model that results in some quality control and credibility issues. Contributors literally pay to be published in SR (âarticle processing feesâ). What could possibly go wrong? đ€·đ»ââïž
There are certainly many good papers in SR. But there is obviously a lot of junk, too â and they certainly do benefit from the reputation of Nature. Which is a teensy bit gross.
But, welp, this paper confirms my bias against SMT, so it must be a good one despite the source! đ€Ł
~ Paul Ingraham, PainScience.com publisher
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