Manual therapy such as spinal manipulation is widely used and recommended for one of the most common health problems today: chronic low back pain. However, it is unclear how this manual therapy reduces pain. A new study by Luana Nyirö and colleagues at Balgrist University Hospital and the University of Zurich provides new insights: spinal manipulation appears to alter how the nervous system processes sensory information from the lower back to control balance, and this change is linked to pain relief.
Although spinal manipulation is commonly used to treat chronic low back pain, its effects on the nervous system are not well understood. The researchers therefore examined how the central nervous system integrates sensory information from different parts of the body during balance control. They focused on proprioceptive weighting, the process by which the nervous system prioritizes sensory signals from muscles and joints to maintain posture. In people with chronic low back pain, this balance is often altered, with greater reliance on signals from the ankles and reduced input from the lower back. The study investigated whether a single session of lumbar spinal manipulation, a fast, targeted manual technique (described as high-velocity, low-amplitude (HVLA) manipulation), could shift this sensory balance and whether such changes were linked to pain reduction.
In a randomized controlled trial, 142 adults, including both healthy participants and people with chronic low back pain, were assigned to receive spinal manipulation, spinal mobilization (slower and repetitive movements without the rapid thrust used in HVLA), or no intervention. Before and after the intervention, the researchers assessed which body region the nervous system relied on most to maintain balance.
The results showed that spinal manipulation had a distinct effect on proprioceptive weighting. Compared with mobilization or no treatment, spinal manipulation shifted balance control more strongly toward greater reliance on sensory signals from the lower back muscles. This effect occurred in both healthy participants and those with chronic low back pain. Importantly, among patients, spinal manipulation reduced pain more than the other interventions, and this benefit was strongest in those whose nervous system already relied more on lower‑back sensory signals before treatment.
Overall, these findings suggest that spinal manipulation may ease pain not only through mechanical effects on the spine, but also by changing how the nervous system prioritizes body signals. Although the effects were investigated only in the short term, the work points toward a more personalized approach to treating chronic low back pain – one that considers individual differences in how the nervous system processes bodily signals and may help predict who benefits most from spinal manipulation.
Reference: Nyirö L, Dörig M, Suter M, Connolly L, Vogel N, Stadler C, et al. The impact of spinal manipulation on lumbar proprioception and its link to pain relief: a randomized controlled trial. Scientific Reports. 2025; 15. https://doi.org/10.1038/s41598-025-25985-3
Useful links:
- Research team homepage:
https://www.balgrist.ch/en/research/research-units/research-chiropractic/
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