Changes in biochemical markers following a spinal manipulation–a systematic review update

Kesava Kovanur Sampath, Loïc Treffel, Oliver P.Thomson, Jerry Draper Rodi, Michael Fleischmann, Steve Tumilty

Research output: Contribution to journalReview article

1 Citation (Scopus)


Objective: The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or symptomatic population. Methods: This is a systematic review update. Various databases were searched (inception till May 2023) and fifteen trials (737 participants) that met the inclusion criteria were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. Outcome measure data were synthesized using standard mean differences and meta-analysis for the primary outcome (biochemical markers). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest. Results: There was low-quality evidence that spinal manipulation influenced various biochemical markers (not pooled). There was low-quality evidence of significant difference that spinal manipulation is better (SMD −0.42, 95% CI − 0.74 to −0.1) than control in eliciting changes in cortisol levels immediately after intervention. Low-quality evidence further indicated (not pooled) that spinal manipulation can influence inflammatory markers such as interleukins levels post-intervention. There was also very low-quality evidence that spinal manipulation does not influence substance-P, neurotensin, oxytocin, orexin-A, testosterone and epinephrine/nor-epinephrine. Conclusion: Spinal manipulation may influence inflammatory and cortisol post-intervention. However, the wider prediction intervals in most outcome measures point to the need for future research to clarify and establish the clinical relevance of these changes.

Original languageEnglish
JournalJournal of Manual and Manipulative Therapy
Publication statusPublished - 2023


  • Biochemical Markers
  • Cortisol
  • Inflammatory Markers
  • Pain Markers
  • Spinal Manipulation


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