SMT in Older Adults: Reasonable Care, Not a Magic Bullet — Here’s What the Research Says

Older adults are among the most common patients in chiropractic practice – and also among the most underrepresented in clinical trials. An updated systematic review just published in the Journal of the Canadian Chiropractic Association (2026) takes a focused look at the evidence for spinal manipulative therapy (SMT) specifically in older adults with chronic spinal conditions, and the findings are clinically useful precisely because they are honest.

What the Study Found

The review included seven randomized controlled trials covering 1226 patients with average ages ranging from 64 to 75 years, across chronic low back pain, chronic neck pain, lumbar spinal stenosis, and combined spinal disability. Five of the seven trials were rated high quality with low risk of bias.

The headline finding is straightforward: SMT generally performed comparably to other recommended conservative treatments, with modest advantages in specific areas.

Here’s what that looked like by condition:

Lumbar spinal stenosis: A promising but preliminary signal – manual therapy plus individualized exercise outperformed medical care and group exercise at 2 months, though the difference didn’t reach the minimal clinically important difference

Chronic low back pain: Mostly neutral results – no significant between-group differences for pain or disability across three trials; no meaningful difference between thrust and non-thrust techniques, or between 12 and 36 weeks of care

Chronic neck pain: The most favourable signal – one trial found SMT combined with home exercise and advice produced greater pain reduction at 12 weeks than exercise-based alternatives, and a secondary analysis suggested lower societal costs and better outcomes over 1 year

Overall certainty of evidence ranged from very low to moderate – an important caveat for any clinical interpretation.

What This Means in Practice

This paper is worth reading not because it makes a strong case for SMT, but because it makes a fair one – and in an older population, that distinction matters.

Treating older adults with chronic spine pain means navigating multimorbidity, polypharmacy, frailty, and limited tolerance for aggressive rehabilitation. If SMT performs comparably to other guideline-concordant conservative options in this population, that’s clinically meaningful – it gives you a non-pharmacological tool that may be appropriate where medications carry higher risk or where active exercise is difficult to implement independently.

The practical takeaway: SMT appears to work best in older adults as part of a multimodal plan – combined with exercise, advice, and patient-centred goal setting – rather than as a standalone treatment. The neck pain and lumbar spinal stenosis signals are worth noting, while the low back pain findings counsel appropriate restraint in your clinical claims.

📋 Clinical Takeaway: SMT is a reasonable conservative care option for older adults with chronic spinal conditions – comparable to other non-surgical approaches, with modest advantages for neck pain and possibly lumbar spinal stenosis. Use it as one tool in an individualized plan, not a standalone solution. Evidence certainty: very low to moderate.

This Week’s Research Review

“Efficacy of SMT in Older Adults with Chronic Spinal Conditions” — published in the Journal of the Canadian Chiropractic Association (2026)

📄 Get the full review — including complete trial breakdowns, GRADE evidence ratings, and a detailed clinical application section: [Access the review here]

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About the Author

Dr. Shawn Thistle, DC – 20+ years in clinical practice, founder of RRS Education and www.shawnthistle.com, research review and knowledge transfer specialist.