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25 From 2025! The Top Research Studies In Chiropractic For The Practicing Chiropractor

Once again we present our annual selection of some of the most useful research studies for the practicing chiropractor!

Here are 25 articles published in 2025 relating directly to chiropractic care and especially spinal manipulation and chiropractic adjustments. Note: We interchangeably use the terms chiropractic manipulative therapy (CMT) and spinal manipulation (SMT) for the chiropractic adjustment.

Read, share, and use for the benefit of your patient care!

  1. More Chiropractic Visits Helped Chronic Back Pain Patients: Veterans with chronic low back pain responded better to a higher dose of chiropractic care (8-12 visits) versus a lower dose care (1-5 visits) over an initial 10-week period for physical functioning, pain intensity and pain severity.

Takeaway: For chronic patients, longer care plans with more doses of treatment are needed.

Link: APHA

  1. 12 weeks of Chiropractic Care Modulates Biomarkers Linked to Neuroplasticity, Inflammation, and Stress: Increases in brain-derived neurotrophic factor and interleukin-6 suggest enhanced neuroplasticity and inflammatory responses, while decreases in tumor necrosis factor-alpha indicate a regulatory effect on systemic inflammation. These findings support the notion that chiropractic care modulates physiological systemic biomarkers, which may underscore its benefits on clinical outcomes.

Takeaway: Chiropractic care has systemic effects and is more than just for pain relief.

Amjad I, Niazi IK, Kumari N, Ghani U, Rashid U, Duarte FCK, Fortuna F, Iglesias S, Gonzalez D, Sumich A, Fabre B, Holt K, Haavik H. The effects of 12 weeks of chiropractic spinal adjustments on physiological biomarkers in adults: A pragmatic randomized controlled trial. PLoS One. 2025 Dec 11;20(12):e0338730. doi: 10.1371/journal.pone.0338730. PMID: 41379843; PMCID: PMC12697962.

Link: Plos1 journal

  1. Cervical manipulation causes less strain on the vertebral artery than passive range of motion: This systematic review and meta-analysis provide consistent evidence that cervical SMT induces less strain on the VA, particularly within the V3 segment, compared to passive cervical ROM.

Takeaway: A properly applied Chiropractic adjustment to the cervical spine is less stressful on the vertebral artery than doing a range of motion exam or any activity involving cervical range of motion.

STRAIN in vertebral artery during passive cervical range of motion and spinal manipulation therapy: A systematic review and meta-analysis. Fagundes, Caroline et al.Clinical Biomechanics, Volume 130, 106685. Link: clinbiomech

  1. Ten myths of back pain in older adults that can lead to ineffective and harmful care:  Key myths debunked include: back pain is inevitable with aging; imaging shows the “damage” that is causing back pain; people with back pain should avoid lifting heavy objects, twisting or bending activities;  treatments like injections, strong medications, or surgery are effective; bed rest is recommended;  , while education, gradual activity, and self-management are key.

Takeaway:This article contains excellent take home messages for clinical practice and patient education.

Ammendolia, C. Ten myths of back pain in older adults that can lead to ineffective and harmful care. Chiropr Man Therap 33, 45 (2025). Link: 10 Myths

  1. Spinal Manipulation Therapy (SMT) for Patients With Low Back Pain (LBP) Results In Less Opioid Use: In this retrospective cohort study, adults receiving SMT for LBP with or without sciatica had a significantly lower risk of developing an opioid use disorder over a 2-year follow-up compared to those prescribed ibuprofen.

Takeaway: In the long-term, chiropractic care reduces opioid drug use.

Trager RJ, Cupler ZA, Gliedt JA, Fischer RA, Srinivasan R, Thorfinnson H. Association Between Spinal Manipulative Therapy for Low Back Pain With or Without Sciatica and Opioid Use Disorder: A Retrospective Cohort Study. Health Sci Rep. 2025 Sep 19;8(9):e71267. doi: 10.1002/hsr2.71267. PMID: 40978305; PMCID: PMC12447351. Link: Opiod

  1. SMT Results In Less Medication Use For Tension-Type Headache (TTH) Patients: This study found a significant reduction in likelihood of both butalbital prescription and, medication overuse, through 2-years’ follow-up among adults with TTH receiving SMT compared to a non-SMT controls group.

Takeaway: In the long-term, chiropractic care reduces drug use.

Trager, R.J., Williamson, T.J., Makineni, P.S. and Morris, L.H. (2024), Association Between Spinal Manipulation, Butalbital Prescription, and Medication Overuse Headache in Adults With Tension-Type Headache: Retrospective Cohort Study. Health Science Reports, 7: e70218. Link: Headache

  1. Positive Expectations Enhance the Immediate Analgesic Effects of Spinal Manipulation (SM): Expectations emerged as the strongest explanatory variable of pain reduction in patients receiving SM. Positive expectations lead to substantial decreases in pain intensity, while fear of SM showed no significant effect on pain outcomes. The verbal context in which SM is performed may be as therapeutically potent as the mechanical technique itself. In practical terms, a brief, positively framed introduction to the technique (emphasizing its safety and likely benefit) can markedly enhance immediate pain relief. Clinicians should deliberately integrate optimistic yet realistic expectation-shaping statements into their consent and treatment scripts, ensuring that patients enter the procedure with a mindset conducive to analgesia.

Takeaway: Words matter. What you say to a patient is part of the adjustment visit and the healing process.

Valera-Calero JA, Buffet-García J, Kocot-Kępska M, Kosson D, Kołacz M, Plaza-Manzano G. Relative contribution of real/sham spinal manipulation performance, changes in cortisol levels, and patient expectations and fear behaviors in modulating short-term pain relief in people with neck pain: A secondary analysis of a randomized clinical trial. Musculoskelet Sci Pract. 2025 Nov;80:103409. doi: 10.1016/j.msksp.2025.103409. Epub 2025 Sep 8. PMID: 40953550. Link: Words

8. Positive Suggestions Improve the Short-term Effects of Spinal Manipulation: Pre-treatment verbal framing may influence pain intensity, stress, and pressure sensitivity. Positive suggestions improved short-term clinical effects of lumbar spinal manipulation. Negative suggestions reduced benefits. Neutral ones produced intermediate effects. Their influence was stronger for self-reported measures, such as pain and stress, than on mechanistic outcomes, such as tissue temperature, blood biomarkers, and lumbar AROM.

Takeaway: Guide patients to a better outcome and recovery with positive, reasonable suggestions.

Zaworski K, Baj-Korpak J, Tokarska-Rodak M, Plażuk E, Dyrda A, Bialosky J, Rossettini G. Can pre-treatment verbal suggestions influence the short-term effects of spinal manipulation in young adults with chronic non-specific low back pain? A randomized controlled trial. Musculoskelet Sci Pract. 2025 Nov;80:103431. doi: 10.1016/j.msksp.2025.103431. Epub 2025 Oct 10. PMID: 41106172.

Link: Suggestions

  1. Spinal Mobilization and Manipulation Reverse Herniated Discs:

In patients with lumbar disc herniations (LDH), manipulation and mobilization were found to have positive effects on the regression of the herniation’s distance; an increase in the disc height and facet joint distance; improvements in functional status, ROM, flexibility, and reduced pain. Interestingly, they used a multi-planer SM treatment approach performing 3 separate manipulations each visit, involving 3 planes of application: P-A mobilization, rotational mobilization, and flexion-position mobilization.

Takeaway: CMT can help patients with lumbar HNP to heal. Consider using a multi-planer approach.

Taşkaya, B., Taşkent, İ., Çakıllı, M., & Yılmaz, Ö. (2025). Is regression in lumbar disk herniation possible by spinal mobilization? A single-blind randomized controlled clinical study. International Journal of Osteopathic Medicine, 100760. Link: Disc

  1. SMT is Effective For Patients With Radiculopathy: High velocity low amplitude (i.e. thrust) techniques have been shown to provide greater reduction in pain and disability in patients with cervical and lumbar radiculopathy in the short term and medium term compared with sham HVLAT interventions, conventional physical therapy alone, and spinal mobilization.

Takeaway: Chiropractic adjustments are more effective at resolving radiculopathies than physical therapy or mobilizations.

Giovannico G, Cioeta M, Giannotta G, Bargeri S, Brindisino F, Pellicciari L. Efficacy of Spine High-Velocity Low-Amplitude Thrust Manipulations in Patients With Radiculopathy: A Systematic Review With Meta-Analysis. J Orthop Sports Phys Ther. 2025 Oct;55(10):649-660. doi: 10.2519/jospt.2025.13103. PMID: 41002235. Link: Radiculopathy

  1. Chiropractic Care Demonstrated to Be Safer Than Medical Care: For Medicare Part B beneficiaries with new onset neck pain, management with chiropractic care was associated with lower rates of adverse events than primary medical care (PCO). The PCO group was divided into Prescription Drug Therapy (PDT) or primary care without medication. PDT group had the highest risk of any measured adverse outcome. This was the ACA RAC award winning paper.

Takeaway: Chiropractic care is again proven to be safer than drug therapy for neck pain.

Whedon JM, Anderson B, Mackenzie TA, Grout L, Moonaz S, Lurie JD, Haldeman S. Observational Study of the Safety of Chiropractic vs Medical Care Among Older Adults With Neck Pain. J Manipulative Physiol Ther. 2025 Sep 9:S0161-4754(25)00002-8. doi: 10.1016/j.jmpt.2025.07.002. Link: Safety

12. Spinal Manipulation Improves the Cardiac Autonomic Control in Patients with Musculoskeletal Pain: In patients with musculoskeletal pain, one session of spinal manipulation on the upper thoracic spine led to an immediate improvement in the resting cardiac autonomic control without an effect on the blood pressure responsiveness to a sympathoexcitatory stimulus. Myofascial manipulation or placebo did not change cardiovascular autonomic control.

Takeaway: SMT produces positive responses in the autonomic nervous system.

Rodrigues, Pedro Teixeira Vidinha MSca; Corrêa, Leticia Amaral MSca; Reis, Felipe José Jandre PhDb; Meziat-Filho, Ney Armando PhDa; Silva, Bruno Moreira PhDc; Nogueira, Leandro Alberto Calazans PhDa,b. One Session of Spinal Manipulation Improves the Cardiac Autonomic Control in Patients with Musculoskeletal Pain: A Randomized Placebo-Controlled Trial. SPINE 46(14):p 915-922, July 15, 2021. | Link: Cardiac

  1. Factors of Patient Satisfaction with Chiropractic Care:

This was a systematic review and a comprehensive overview of patient satisfaction with chiropractic care.  Patients reported high levels of satisfaction and positive experiences with their care. Patient experiences are more positive across several important domains including empathy, patient centredness, and perceived support when compared to medical doctors. Generally, where substantive clinician time or attention was involved, patients were more satisfied. Patients noted good communication, being listened to, the development of a strong therapeutic relationship and key traits such as trustworthiness and caring as being central in underpinning positive experience. This included components such as: practitioner caring about patient, practitioner accepting patient, trust for practitioner, talking openly with practitioner. Patients valued the professionalism of their practitioners, which they noted in the way chiropractors communicated with them. Patients valued effective communication of their diagnosis and the treatment plan.

Takeaway: Use the findings in this study to improve your patient’s satisfaction with care and build your practice! It’s more than just delivering a good adjustment and clinical care.

Newell D, Holmes MM. Patient Experience and Satisfaction With Chiropractic Care: A Systematic Review. Journal of Patient Experience. 2024;11. Link: Satisfaction

  1. General and Specific Spinal Manipulations Are Shown to Be Equally Effective: The average treatment effect of spinal manipulative therapy (SMT) for reducing pain and disability in patients with spinal pain does not appear to depend on where the SMT was targeted, how the thrust was performed, and in what region it was delivered. The highest probability of providing the greatest average treatment effects for reducing pain and disability was observed for “more general and nonspecific” SMT applications. The authors recommend that clinicians should select SMT procedures based on patient and clinician safety, comfort, preferences, and body characteristics. They also acknowledge the limitations of this systematic review.

Takeaway: Even general spinal manipulation can be beneficial.

Nim C, Aspinall SL, Cook CE, Corrêa LA, Donaldson M, Downie AS, Harsted S, Hansen S, Jenkins HJ, McNaughton D, Nyirö L, Perle SM, Roseen EJ, Young JJ, Young A, Zhao GH, Hartvigsen J, Juhl CB. The Effectiveness of Spinal Manipulative Therapy in Treating Spinal Pain Does Not Depend on the Application Procedures: A Systematic Review and Network Meta-analysis. J Orthop Sports Phys Ther. 2025 Feb;55(2):109-122. doi: 10.2519/jospt.2025.12707. PMID: 39869665. Link: SMT

  1. SMT is Safe in Adults With Prior Spine Surgery: This study found no incidents of serious adverse events in the short-term following SMT in individuals with prior spine surgery. The most common types of spine surgeries were lumbar fusion (28.7%), cervical fusion (27.8%), and lumbar discectomy with laminectomy/foraminotomy (34.7%). The median time after surgery to first SMT was 311 days. There were no short-term incidents of vertebrobasilar/cervical artery injury, acute cauda equina, fractures in the same region of SMT application, or hardware failure.

Takeaway: Don’t shy away from treating patients who have had prior spinal surgery.

Gliedt JA, Gruttke J, Jones A, King J, Spector AL, Daniels CJ, Wang MC. A description of serious adverse events following spinal manipulative therapy for adults with history of spine surgery: a single institution retrospective chart review. J Man Manip Ther. 2025 Oct;33(5):430-440. doi: 10.1080/10669817.2025.2501054. Epub 2025 May 3. PMID: 40317216; PMCID: PMC12459164.

Link: Post-surgical

  1. SMT Results In Lower Costs For Care of Older Neck Pain Patients: Initial spinal manipulative therapy was associated with a significant reduction in downstream care escalation encounters among Medicare beneficiaries with new episodes of neck pain. Patients who received spinal manipulation first experienced a 77.8% decrease in hospitalizations and a jaw-dropping 93.3% reduction in surgeries.

Takeaway: Patients seeing a DC first saves costs, have less hospitalizations and testing, and fewer invasive interventions.

Anderson BR, MacKenzie TA, Lurie JD, Grout L, Whedon JM. Patterns of initial treatment and subsequent care escalation among medicare beneficiaries with neck pain: a retrospective cohort study. Eur Spine J. 2025 Feb;34(2):724-730. doi: 10.1007/s00586-024-08581-3. Epub 2024 Dec 26. PMID: 39722095. Link: Costs

  1.  Cervical Manipulation Reduces Systolic Blood Pressure: The findings of this scoping review suggest that cervical manipulation may induce a hypotensive response in systolic blood pressure while promoting an overall enhancement in cardiovascular regulation, particularly through an increase in parasympathetic activity. Specifically, 80 % of the reviewed studies reported a reduction in systolic blood pressure following cervical manipulation, highlighting its potential as a therapeutic strategy for blood pressure management. Additionally, 66 % of the included studies demonstrated improvements in sympathetic-vagal balance regulation.

Takeaway: Cervical SMT is helpful as a part of the management strategy for people with hypertension.

Monteiro ER, de Oliveira Muniz Cunha JC, de Souza Horsth T, de Araujo Barros I, de Souza RC, de Andrade WCR, Corrêa Neto VG, de Sá Ferreira A, de Jesus IRT. Effect of cervical manipulation on blood pressure and heart rate variability responses in adults: A scoping review. J Bodyw Mov Ther. 2025 Jun;42:1120-1127. doi: 10.1016/j.jbmt.2025.03.023. Epub 2025 Mar 17. PMID: 40325646.

Link: Hypertension

  1. The Mechanisms of Manipulation and Manual Therapy Explained: Chiropractic adjustments, spinal manipulation, and manual therapy techniques produce results and effects that are clearly observed in our practice. There are dozens of mechanisms to explain these effects. This paper summarizes the reported and investigated mechanisms involved and puts them in an organized appealing model with excellent visuals.

Takeaway: There’s a lot going on when we adjust patients! Learn how what you do as a DC affects the patients under your care.

Keter DL, Bialosky JE, Brochetti K, Courtney CA, Funabashi M, Karas S, Learman K, Cook CE. The mechanisms of manual therapy: A living review of systematic, narrative, and scoping reviews. PLoS One. 2025 Mar 18;20(3):e0319586. doi: 10.1371/journal.pone.0319586. PMID: 40100908; PMCID: PMC11918397. Link: Manual Therapy

  1. Patient Survey Reveal a 97% Patient Satisfaction With Chiropractic Care: 97% of Chiropractic patients in Denmark reported ‘very high’ or ‘high’ degree of overall satisfaction with Chiropractic care. Patients reported ‘very high’ or ‘high’ levels of confidence that they were receiving the right care (97%), that the visit met their expectations (95%), and overall satisfaction with care (97%). The domains that contributed the most to overall satisfaction were those involving personal experience with the chiropractor, such as examination and communication, patient involvement and information, and reassurance. In contrast, domains related to clinic facilities, such as clinic accessibility, clinic contact and reception, and clinic area premises, contributed less to overall satisfaction.

Takeaway: Patients are very very satisfied with chiropractic care.

Lyskjær, L., Vach, W., Nim, C. et al. Patient experience and satisfaction with chiropractic care: a national survey. BMC Health Serv Res (2025). Link: Patient Experience

  1. Multimodal Treatment That Includes Manipulation is the Most Effective Treatment for Patients with Neck Pain: This systematic review and meta-analysis found that a multimodal treatment program (the combined use of two or more musculoskeletal manipulations, mobilizations, manual therapy, and soft-tissue manipulation) is the most effective intervention for reducing both neck pain intensity and neck disability. Manipulation is the most effective for improving cervical range of motion.

Takeaway: SMT is most effective when used with other modalities.

Gong Z, Liu W, Gao Y, et alEffectiveness of musculoskeletal manipulations in patients with neck pain: a systematic review and network meta-analysisBMJ Open 2025;15:e098682. doi: 10.1136/bmjopen-2024-098682. Link: Multimodal

  1.  The Questionable Safety and Effectiveness of Y-Axis Manipulation: Popular on You Tube videos and social media, the Y-strap and Y-axis manipulation is examined in this clinical commentary. The authors conclude that despite the positive claims of patient benefits, the technique has little robust scientific evidence to substantiate these claims. Concerns about the safety of the technique include overstretching of spinal structures, nerve damage, and exacerbation of pre-existing spinal pathologies. The absence of measurable force parameters and patient-specific application further compounds the uncertainty surrounding its safety.

Takeaway: High forceY-axis manipulations should be used with caution, if at all.

Gyer G, Williams B, Cox RM, Bowie J, Michael J. THE Y-AXIS MANIPULATION—THE CLINICAL EFFICACY AND ASSOCIATED PATIENT SAFETY EXPLORED—A CLINICAL COMMENTARY. Journal of Contemporary Chiropractic. 2025;8:50–60. Link: Y-Axis

  1. Directional Preference is Shown to Have Good Diagnostic Accuracy: Directional Preference (DP) is a movement and loading direction that produces rapid, lasting, reproducible, and reversible improvement in a patient’s back pain or radicular symptoms. This study compared the findings of the participant’s lumbar DP with a lumbar discography and assessed the correlation between them. They found that DP has good diagnostic accuracy and specificity (over 90%) for identifying a back pain subgroup the authors have termed “mechanical discogenic pain”- the type most responsive to manual and mechanical treatment methods (as opposed to other types of pain like inflammatory pain). DP had fair sensitivity (~ 50%), making it a poor general screening tool for lumbar disc syndrome (i.e. more than 50% of patients with proven discogenic pain did not show the directional preference or centralisation response to repeated movement testing).

Takeaway: Diagnosing some types of lumbar disc herniations can be done on examination with a high degree of confidence without an MRI or advanced imaging.

Deneuville JP, Laslett M, Cervantes A, Peterlongo S, Ounajim A, Artico R. Concurrent validity of the directional preference phenomenon compared to controlled lumbar discography: A supplementary analysis of a diagnostic accuracy study. Musculoskelet Sci Pract. 2025 Nov;80:103413. doi: 10.1016/j.msksp.2025.103413. Link: DP

  1. Thoracic Spinal Manipulation Improves Pulmonary Function and Thoracic Spine Mobility in Patients with Long COVID: This study found thatthoracic spinal manipulation with pulmonary rehabilitation improves pulmonary function measures of FEV1 (Forced Expiratory Volume in 1 second) and FVC (Forced Vital Capacity)) in Long COVID patients. These improvements were not seen in patients with pulmonary rehabilitation alone.

Takeaway: Thoracic SMT improves lung function, and can help long COVID patients.

Aggarwal A, Chanda A. Effects of thoracic spinal manipulation in long COVID patients: A randomised controlled trial. Respir Med. 2025 Dec;250:108503. doi: 10.1016/j.rmed.2025.108503. Epub 2025 Nov 12. PMID: 41237918.Link: Post-Covid

  1. Convergence of Risk Factors Leads to a Diagnosis of Vertebral Artery Dissection: Patients with a vertebral artery dissection (VAD) present a diagnostic challenge to all physicians. There is no one single risk factor, symptom, or finding in their history or physical examination that is indicative of its presence. This case study is fascinating and instructive, as the patient presented with a convergence of several findings that led the chiropractor to suspect this diagnosis. The patient was a young postpartum female, who suffered from preeclampsia during her pregnancy. She had a connective tissue disease and a history of migraines. She presented with neck pain, visual disturbance, and dizziness. Each of these signs or risk factors do not present a strong cause of suspicion for VAD, but the concurrence of them should raise a warning of its presence.

Takeaway: Taking a good history is the best way to screen for risk factors suggestive of VAD.

Demetrious J, Trager RJ, Veigh S, Tuchin P, Graber D. Recognition of Vertebral Artery Dissection in a High-Risk Postpartum Patient by a Chiropractic Physician. Cureus. 2025 Aug 18;17(8):e90389. doi: 10.7759/cureus.90389. PMID: 40970038; PMCID: PMC12442746. Link: VAD

  1. Take An In-depth Look At The Chiropractic Profession: The NBCE conducted research and surveys and produced the report, “Practice Analysis of Chiropractic 2025”. The document is a comprehensive profile of the chiropractic profession as it stands today. The study’s findings contribute to evidence-based decision-making by offering a data-driven overview of the chiropractic profession. You can download a copy here: NBCE

About the Author

Dr. David Graber is a nationally known presenter on chiropractic technique and is a member of the ANJC Board of Directors. He maintains a private practice in Parsippany, NJ. He blogs on chiropractic and clinical topics at chiro-excellence.com/, and he can be reached at DrDavidGraber@gmail.com.

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