What is it about?

Researchers analyzed 11,000+ episodes of back pain care, which were grouped into no spinal manipulation (SMT) visits, low (1 SMT visit), moderate (2-12 SMT visits) and high (13+ SMT visits) dose cohorts. The SMT and no SMT cohorts were compared regarding exposure to imaging studies, injection procedures, emergency room visits, surgery and opioid medications (e.g., escalated spine care). Statistical matching made the groups more comparable. The findings showed that exposure to escalated spine care was significantly reduced in the low and moderate dose SMT cohorts, with mixed results in the high SMT cohort. Those in the low dose cohort were 55% less likely to be exposed to any escalated care, while those in the moderate dose were 42% less likely (both vs no SMT). The high dose and no SMT cohorts were about equally likely to be exposed to any escalated care.

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Why is it important?

The dose-response relationship between SMT visits and low value care exposures has important implications for providers deciding on best practices and for policymakers determining insurance coverage for SMT, which is often limited to a specific number of visits per year.


SMT is guideline-concordant and both clinically effective and cost-effective for the management of LBP. This study now indicates that SMT helps individuals with LBP avoid expensive and often unnecessary interventions. However, SMT remains underutilized and often trails behind primary care, medical specialty care and physical therapy. The ever-increasing costs associated with LBP management are not sustainable; it is our hope that policymakers incentivize high-value care such as SMT.

Brian Anderson
Palmer College of Chiropractic

Read the Original

This page is a summary of: Dosing of lumbar spinal manipulative therapy and its association with escalated spine care: A cohort study of insurance claims, PLoS ONE, January 2024, PLOS,
DOI: 10.1371/journal.pone.0283252.
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