To the EditorI read with interest the article by Goertz et al. that offers alternate conclusions about 6 trials showing no or equivocal effect of spinal manipulative therapy (SMT) as a sole intervention on 5 unrelated nonmusculoskeletal (non-MSK) problems.1Goertz CM Hurwitz E Murphy B Coulter I Extrapolating beyond the data in a systematic review of spinal manipulation for nonmusculoskeletal disorders: a fall from the summit [e-pub ahead of print]. This is hardly new information, although as noted in this article there remains considerable debate on the quality and relevance of the available research. There is, however, a more relevant question that was not considered: Do patients with non-MSK disorders benefit from seeing a clinician who practices SMT?Patients with non-MSK symptoms report improvement of symptoms when receiving care from practitioners of SMT. This is not unique to chiropractic but is reported by patients of medical or osteopathic physicians, Tuina (China), Shiatzu (Japan), Ayurveda (India), Sobadores (Mexico), and other health care providers that practice some form of manual therapy. Millions of people for centuries have reported these responses. Independent studies have confirmed that patients with non-MSK symptoms report symptom improvement following care by chiropractors.2Leboeuf-Yde C Axén I Ahlefeldt G Lidefelt P Rosenbaum A Thurnherr T The types and frequencies of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy.,3Leboeuf-Yde C Pedersen EN Bryner P et al.Self-reported nonmusculoskeletal responses to chiropractic intervention: a multination survey. These experiences could be owing to placebo, natural fluctuation of symptoms, the impact of factors unrelated to the intervention, regression to the norm, or other issues. We simply do not know.Non-MSK disorders have a high comorbid association with spine pain.4de Luca KE Parkinson L Haldeman S Byles JE Blyth F The relationship between spinal pain and comorbidity: a cross-sectional analysis of 579 community-dwelling, older Australian women.,5Green BN Johnson CD Haldeman S et al.A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders. The question of causality must wait for longitudinal studies, but there is some early research that suggests that relieving pain can have a substantial benefit for some incapacitating non-MSK disorders.5Green BN Johnson CD Haldeman S et al.A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders., 6Rodriguez-Raecke R Niemeier A Ihle K Ruether W May A Brain gray matter decrease in chronic pain is the consequence and not the cause of pain., 7Seminowicz DA Wideman TH Naso L et al.Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function. Spinal manipulative therapy is generally accepted to be of value in reducing pain and disability. Relief of pain and especially increased activity, in turn, has considerable multiorgan physical and psychological health benefits.5Green BN Johnson CD Haldeman S et al.A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders. It is biologically plausible that these factors might explain the reported improvement of non-MSK disorders when comorbid spine pain and disability are reduced after SMT.Practitioners of SMT use multiple modalities. There is considerable evidence that chiropractors include in their clinical regimen advice on exercise, diet, smoking, alcohol use, and other public health messages.8Fernandez M Moore C Eklund A et al.The prevalence and determinants of physical activity promotion by Australian chiropractors: a cross sectional study. They inevitably include education, reassurance, empathy, relaxation, and sometimes other modalities such as acupuncture and mind-body therapies, including yoga or tai chi. These interventions are increasingly being recommended for a variety of non-MSK disorders.5Green BN Johnson CD Haldeman S et al.A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders. It is biologically probable that broader public health and psychosocial interventions integral to the practice of SMT providers might benefit non-MSK complaints.As noted by Goertz et al., current research does not support claims that standalone SMT has an impact on individual non-MSK disorders.1Goertz CM Hurwitz E Murphy B Coulter I Extrapolating beyond the data in a systematic review of spinal manipulation for nonmusculoskeletal disorders: a fall from the summit [e-pub ahead of print]. However, the observations of patients seeking the care of a SMT clinician in real-life situations has not been studied. Patients and clinicians rely on researchers to conduct and interpret available evidence. It is the responsibility of the research community to study and explain observations noted by patients and clinicians who have direct experience with the intervention. Hopefully, the current focus of attention on this issue will result in increased research and understanding of this very controversial question that has divided the research community from patients and clinicians who are asking for an explanation, understanding, and guidance on how to interpret their personal experience.ReferencesGoertz CM Hurwitz E Murphy B Coulter I

Extrapolating beyond the data in a systematic review of spinal manipulation for nonmusculoskeletal disorders: a fall from the summit [e-pub ahead of print].

J Manipulative Physiol Ther. ()https://doi.org/10.1016/j.jmpt.2021.02.003Leboeuf-Yde C Axén I Ahlefeldt G Lidefelt P Rosenbaum A Thurnherr T

The types and frequencies of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy.

J Manipulative Physiol Ther. 22: 559-564Leboeuf-Yde C Pedersen EN Bryner P et al.

Self-reported nonmusculoskeletal responses to chiropractic intervention: a multination survey.

J Manipulative Physiol Ther. 28 (): 294-302de Luca KE Parkinson L Haldeman S Byles JE Blyth F

The relationship between spinal pain and comorbidity: a cross-sectional analysis of 579 community-dwelling, older Australian women.

J Manipulative Physiol Ther. 40: 459-466Green BN Johnson CD Haldeman S et al.

A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders.

PLoS One. 13e0197987Rodriguez-Raecke R Niemeier A Ihle K Ruether W May A

Brain gray matter decrease in chronic pain is the consequence and not the cause of pain.

J Neurosci. 29: 13746-13750Seminowicz DA Wideman TH Naso L et al.

Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.

J Neurosci. 31: 7540-7550Fernandez M Moore C Eklund A et al.

The prevalence and determinants of physical activity promotion by Australian chiropractors: a cross sectional study.

Complement Ther Med. 45: 172-178Article InfoPublication History

Published online: June 20, 2021

Accepted: April 19, 2021

Received: April 19, 2021

Publication stageIn Press Corrected ProofIdentification

DOI: https://doi.org/10.1016/j.jmpt.2021.04.010

Copyright

© 2021 by National University of Health Sciences.

ScienceDirectAccess this article on ScienceDirect Related Articles