Rubinstein et al. 2019, Spinal manipulative therapy for chronic low back pain (systematic review)

BMJ systematic review and meta-analysis of 47 randomised controlled trials of spinal manipulative therapy (SMT) for chronic low back pain. SMT produced small, clinically modest improvements in pain and function that were similar to those from other recommended therapies such as exercise. The quality of the evidence was generally low to moderate. Serious adverse events were rare but poorly reported; transient minor effects (short-lived increased pain or stiffness) were common. The headline: SMT is one reasonable option among several with comparable, modest effects, not a standout.