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@Tryptofish requested that we reach consensus on the changes I would like to make to the part of the effectiveness lead.

The sentence as it reads now:

There is no good evidence that chiropractic manipulation is effective in helping manage lower back pain.^[1][2] A 2011 critical evaluation of 45 systematic reviews concluded that the data included in the study "fail[ed] to demonstrate convincingly that spinal manipulation is an effective intervention for any condition."^[3]

My suggested change

Systematic reviews and clinical guidelines report that spinal manipulation may provide small to moderate improvements in pain and function for some people with acute, subacute, or chronic low back pain.^[4][5] Several national and international guidelines recommend spinal manipulation as one of several non-pharmacologic options—typically as part of a multimodal package of care that includes exercise and/or psychological therapies.^[6][7][8]

This reflects newer, higher quality sources that better align with WP:MEDRS with regard to currency, study design, and journal impact factor, as well as incorporating national clinical practice guidelines from US, UK and WHO. Since 2016–2023, multiple high-quality reviews and guidelines have shown that spinal manipulation can produce small to moderate improvements for some LBP patients and is recommended as an option within multimodal, non-pharmacologic care. The replacement text accurately reflects that modern evidence and guidance, whereas the original sentences rely on outdated sources and a blanket negative conclusion that is no longer supported.

The effectiveness section itself needs similar changes as most of the references there are >15 years old and many newer studies are available. Jmg873 (talk) 02:21, 27 October 2025 (UTC)[reply]

Your suggestion is not an improvement, and I would not support a change from the current sentence. I see this LBP claim in many many ALT-MED articles where they all have small to moderate improvements in some patients. The age of a study has little impact on it's conclusions in these sort of cases. I would also suggest that though refs 6, 7 and 8 are perhaps newer than some we use in the article, they do not have sufficient weight to usurp those already extant. Walter Ego 07:32, 27 October 2025 (UTC)[reply]

Further to the above, I note that Trypto didn't say that we reach consensus, but that you have to get consensus for your changes. That is a very different thing, and you have no consensus for the changes you wish to make, and I do not support your changes. - - Walter Ego 11:40, 27 October 2025 (UTC)[reply]

Many of the arguments put forth in your reply are counter to wiki best-practices.

The age of a study has little impact on it's conclusions in these sort of cases.

WP:MEDDATE; recency matters because medical evidence changes. The revised lead reflects multiple independent, high-quality secondary sources that now form the mainstream view.

Your suggestion is not an improvement, and I would not support a change from the current sentence.

the "no convincing evidence" statement conflicts with recent SRs/guidelines and gives WP:UNDUE weight to outdated reviews.

I see this LBP claim in many many ALT-MED articles where they all have small to moderate improvements in some patients.

These aren't alt-med articles. These are two SRs, published in JAMA and BMJ respectively, as well 2 separate national CPGs and 1 international CPG; they represent the scientific consensus on the topic.

I would also suggest that though refs 6, 7 and 8 are perhaps newer than some we use in the article, they do not have sufficient weight to usurp those already extant.

Multiple independent guidelines (ACP, NICE, WHO) converging on similar conclusions carry greater WP:DUE weight than older, single-author narrative/critical reviews from 2007–2011. The goal isn’t to “usurp”, it’s to rebalance the lead so it matches current mainstream summaries.

As a reminder from WP:MEDRS

from time to time, major scientific or medical organizations come out with statements on important issues—the World Health Organization, ... other governmental organizations like the UK's NICE ... organizations like that. Likewise, professional medical associations often generate medical guidelines for diagnosing and treating diseases or conditions. When these organizations make statements, they are summarizing the evidence that exists and providing the mainstream view on it; you can trust those are true as well, and those statements also make great secondary sources for health content on Wikipedia.

(emphasis mine) Jmg873 (talk) 21:50, 27 October 2025 (UTC)[reply]

My changes on safety were also reverted. The existing part of the safety lead I am suggesting we change:

There is not sufficient data to establish the safety of chiropractic manipulations.^[1] It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.^[2]

Suggested Change:

Adverse effects following spinal manipulation are usually mild and transient (for example, local soreness), and serious complications appear rare; however, the true incidence of rare harms remains uncertain because adverse-event definitions and reporting are inconsistent and randomized trials are underpowered to detect very rare events.^[3][4][5]

As with the changes in the evidence lead, these changes represent sources that are in better compliance with WP:MEDRS, mostly for currency, but also study design. The 2023 SR/MA is comprised of RCT's rather than of case-studies that make up the Ernst study. My edits also explain why uncertainty persists instead of implying “insufficient data” in general, which sounds strangely nebulous for how much this has been studied. Jmg873 (talk) 03:20, 27 October 2025 (UTC)[reply]

See my comments above. - Walter Ego 11:41, 27 October 2025 (UTC)[reply]

I'll reply to both talk sections here. In addition to what Walter/Roxy said, all of which I agree with, I'd also request that you look through the talk page archives, because these issues have been discussed in various forms before. It would be helpful to explain what has changed, that would change previous consensus. --Tryptofish (talk) 23:35, 27 October 2025 (UTC)[reply]

I have looked through the talk page archives and was involved in many of those discussions myself. What I am bringing is not a single source, as has been done in the past, but the accumulation of the most reliable sources (CPGs and some recent, large SRs published in top-tier journals). For example, when the ACP guideline was brought up in the talk pages, it was dismissed for not being the scientific consensus because it only represented a single physician group. In this instance I am bringing up the mainstream view and demonstrating it as the mainstream view.

In the case of safety, I don't believe most of the studies I cited have ever been discussed on the talk page. There are several newer, and larger scale studies on C-SMT vs. Stroke/dissection, many of far better design than what is currently cited on the chiropractic page. Those studies have elucidated more about the statistical association and have synthesized more refined conclusions. My correction is balanced in that it maintains that rare serious events happen and are associated with C-SMT, but better explains the reason for the difficulty in proving/disproving causation with the existing literature, rather than a "literature void". It is a material improvement on what is presently written. Jmg873 (talk) 15:14, 28 October 2025 (UTC)[reply]

I generally agree with Walter/Roxy and you -- But I really do wish we could improve on the phrasing "There is not sufficient data to establish the safety of chiropractic manipulations." -- It seems like we're just throwing up our hands and saying it's unknowable. Could we at least give readers some sort of Fermi estimate saying just the order of magnitude of the incidence of adverse events? Feoffer (talk) 16:12, 28 October 2025 (UTC)[reply]

Instead of saying "There is not sufficient data to establish the safety of Chiropractic manipulations" we could say something like "Evidence shows that Chiropractic manipulations have little or no effect, and the risks of treatment seem to outweigh purported benefits"

I would be very interested in what other editors think of this obvious suggestion. - Walter Ego 17:23, 28 October 2025 (UTC)[reply]

I'm generally okay with that conclusion, especially when we consider that we have a global audience: even if the US has seen some improvements since 2015 (per Jmg873;s claims), we still have to be more conservative and recommend our readers planet-wide avoid it. But I do wish we could have numeric estimates on the dangers of serious adverse conditions. Feoffer (talk) 18:43, 28 October 2025 (UTC)[reply]

Your comment concerns me. Please remember WP:NPOV. This comment:

and recommend our readers planet-wide avoid it

is WP:ADVOCACY. Jmg873 (talk) 04:59, 29 October 2025 (UTC)[reply]

I'm personally quite pro-chiropractic, but my personal views don't count. Feoffer (talk) 16:55, 29 October 2025 (UTC)[reply]

I am commenting on what you wrote, not on your personal views. Jmg873 (talk) 19:42, 29 October 2025 (UTC)[reply]

Your suggested replacement statement seems to be WP:SYNTH and not in compliance with WP:MEDDATE or WP:DUE.

Even if you feel the newer sources aren’t sufficient to replace the existing wording, they are certainly of adequate MEDRS quality to supplement it (ACP 2017; NICE NG59; WHO 2023; JAMA 2017; BMJ 2019).

I’m assuming your edits are in good faith. If you disagree that these sources merit inclusion at least as supplementary evidence, I’d appreciate understanding why (MEDRS, DUE, or other specific guideline concerns).

If you do agree, could you clarify how their conclusions (small/modest effects in LBP, conditional use within multimodal care; mostly mild/transient AEs with rare serious events and uncertain cervical causality) are reflected in your proposed replacement sentence? Jmg873 (talk) 04:37, 29 October 2025 (UTC)[reply]

I am inclined to agree with Trypto that many of the same arguments are being put forth here, as in the archives. I have explained why this is different. Seeing as there are policy-based reasons to include the new sources and don't seem to be policy-based reasons not to, I am opening an RFC below to bring in some others voices. Jmg873 (talk) 21:31, 11 November 2025 (UTC)[reply]

{{rfc|sci|rfcid=01A4ABE}} Question: Should the lead be updated so that (a) efficacy is summarized as small to modest effects for low back pain (LBP) with conditional use within multimodal care, and (b) safety is summarized as mostly mild/transient adverse effects, rare serious events, and uncertain causality for cervical artery dissection, in line with recent secondary sources and guidelines?

TL;DR for responders

Option A (status quo): Keep older 2007–2011 reviews front-and-center in the lead.

Option B (partial): Keep either Safety or Efficacy changes, but not both (please specify).

Option C (proposed): Update the lead to reflect small–modest benefits for LBP and conditional, multimodal guideline recommendations, with balanced safety (mild/transient AEs common; rare serious events; causality uncertain with expanded explanation for the uncertainty) per ACP 2017, NICE NG59, WHO 2023, JAMA 2017, BMJ 2019, BMJ Open 2023, Pain Physician 2024.

Background (status-quo wording) Current lead sentences include:

Efficacy:

There is no good evidence that chiropractic manipulation is effective in helping manage lower back pain.^[1][2] A 2011 critical evaluation of 45 systematic reviews concluded that the data included in the study "fail[ed] to demonstrate convincingly that spinal manipulation is an effective intervention for any condition."^[3]

Safety:

There is not sufficient data to establish the safety of chiropractic manipulations.^[4] It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.^[5]

Proposed lead wording (efficacy)

Systematic reviews and clinical guidelines report that spinal manipulation may provide small to moderate improvements in pain and function for some people with acute, subacute, or chronic low back pain.^[6][7] Several national and international guidelines recommend spinal manipulation as one of several non-pharmacologic options, typically as part of a multimodal package of care that includes exercise and/or psychological therapies.^[8][9][10]

Proposed lead wording (safety)

Adverse effects following spinal manipulation are usually mild and transient (for example, local soreness), and serious complications appear rare; however, the true incidence of rare harms remains uncertain because adverse-event definitions and reporting are inconsistent and randomized trials are underpowered to detect very rare events.^[11][12][13]

Argument for change:

WP:MEDRS / WP:MEDDATE / WP:LEAD / WP:DUE – Recent high-quality secondary sources and guidelines should be preferred in the lead. Since 2016, multiple independent, top-tier sources (ACP, NICE, WHO; JAMA/BMJ SR/MAs) converge on the same conclusion: small/modest effect sizes for LBP and conditional, multimodal use. The proposed text mirrors the articles' texts, represents mainstream consensus and avoids over-claiming.

Argument against change:

The newer sources are not of sufficient weight to replace the previous sources. the age of a study has little impact on its conclusion in these sort of cases. SM effectiveness for LBP is an alt-med claim.

Please see Talk:Chiropractic for more details and context.

Thank you in advance for weighing in. Jmg873 (talk) 21:47, 11 November 2025 (UTC)[reply]

• Flawed RfC, should be WP:SNOW-closed. The wording implies, falsely, that this is a matter of simply needing to add recent reliable sources. In fact, it's WP:POV-pushing. The talk section just above shows editors rejecting the premise. --Tryptofish (talk) 22:59, 11 November 2025 (UTC)[reply]

• No See all the responses to you already made above.

Walter Ego 23:36, 11 November 2025 (UTC)[reply]

• No (summoned by bot). Quite apart from anything else, using sources for general Spinal manipulation (which has its own article) in an article about chiropractic (a fairly extreme form of woo), does not serve our readership with the honesty they deserve. (It is also misleading that the RfC says the current text "Keep[s] older 2007–2011 reviews front-and-center" while in fact it is proposing to memory-hole on-point 2021 WP:MEDRS sourcing in deference to sourcing which paint chiropractic in an uncritical light). Bon courage (talk) 03:25, 12 November 2025 (UTC)[reply]

  Using sources on general spinal manipulation (which has its own article) in an article about chiropractic (called here “a fairly extreme form of woo”) does not serve readers honestly.

  Summarizing SMT evidence is appropriate when we’re discussing the treatment modality commonly used by chiropractors (especially the most commonly used by chiropractors for the most common condition that they treat)

  Notably, the very 2008 Ernst paper being cited for efficacy adopts the same modality-level approach:

  Table 3 gives an overview of the most up-to-date systematic reviews by indication.137–144 These systematic reviews usually include trials of spinal manipulation regardless of who administered it. Thus, they are not exclusively an evaluation of chiropractic. Collectively, their results fail to demonstrate that spinal manipulation is effective.

  (emphasis added)

  Ernst relies, for low back pain, on a 2004 Cochrane review that evaluated “any type of SM”, not “chiropractic SM” specifically. In other words, the long-standing critical sources also conflate provider groups at the SMT modality level. If we follow your critique of the new sources, the existing source is no longer an appropriate citation. It is inconsistent to exclude current SMT systematic reviews and guidelines from the chiropractic article now, given that older negative reviews used the same scope. Jmg873 (talk) 04:57, 12 November 2025 (UTC)[reply]

  We cite a 2021 source which considers chiropratic (the one this RfC is trying to ignore / sneak out), alongside Ernst 2008, which is any case does make specific comment on chiropractic:

  The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.

  So what we have is fine, what is proposed looks like POV-pushing. Bon courage (talk) 07:22, 12 November 2025 (UTC)[reply]

  The 2021 source is fine, but for a claim of low back pain, it evaluated a single primary study on chiropractic with an n=153. that doesn't hold a candle to the newer studies in size/scope. Stay focused. What policy-based reasons are there not to include multiple sources that are far more reliable from a MEDRS/MEDDATE standpoint? Jmg873 (talk) 14:30, 12 November 2025 (UTC)[reply]

  "Stay focused" ahaha. Try it yourself. Focus on all the replies you have had disagreeing with you. - Walter Ego 14:39, 12 November 2025 (UTC)[reply]

  I just think it's dishonest to sell an RfC as an "update" when the actual change is to swap out recent sources for old pro-chiropractic ones. Anyway, since the OP is now WP:BLUD and I have provided the responses(s) requested of me, it's time to disengage. Bon courage (talk) 16:38, 12 November 2025 (UTC)[reply]

  Not WP:BLUD at all. I only responded to you. I feel its important for other readers to know that your proposed criteria for excluding the new source would disqualify the existing source as a citation for the statement it is cited for, in case they didn't take the time to read it themselves. Thank you for your contribution to the RfC. Jmg873 (talk) 17:38, 12 November 2025 (UTC)[reply]

• Comment An "Either-Or"/Win-Lose isn't going to work here. Globally, Chiro is in a limbo between real medicine and folk medicine. I don't think this article strikes the right balance yet, millions of people are getting some level of drug-free pain relief... but I don't know how exactly how to improve the article. It's definitely not as simple as "new evidence says chiro is suddenly fine now". Some (hopefully-diminishing) fraction of chiros are selling snake oil, and that's the first thing readers should know. At the same time, lots of chiros have discarded all "woo". It's a very challenging topic -- a reader seeking info on a chiro might be walking into a cost-effective drug-free way to ease pain -- or they MIGHT be walking into a charlatan who says supplement can cure their cancer. This is a hard topic to get right. Feoffer (talk) 15:46, 12 November 2025 (UTC)[reply]
• @Jmg873: what is your brief and neutral statement? At over 9,000 bytes, the statement above (from the {{rfc}} tag to the next timestamp) is far too long for Legobot (talk · contribs) to handle, and so it is not being shown correctly at Wikipedia:Requests for comment/Maths, science, and technology. --Redrose64 🌹 (talk) 22:19, 12 November 2025 (UTC)[reply]

  @Redrose64 Thank you for pointing that out. I've been on Wikipedia awhile, but I'm inexperienced with RfC's. See the statement below:

  Question: Should the lead be updated so that (a) efficacy is summarized as small to modest effects for low back pain (LBP) with conditional use within multimodal care, and (b) safety is summarized as mostly mild/transient adverse effects, rare serious events, and uncertain causality for cervical artery dissection, in line with recent secondary sources and guidelines?

  Is there a way for me to fix that at the RfC page? Thank you for your help. Jmg873 (talk) 05:39, 13 November 2025 (UTC)[reply]

  It is rarely appropriate to make anything but the most minor wording changes to an RfC once it has been replied to. I suggest it is closed, and you then consider discussing more appropriate wording aiming for some sort of consensus on this, before starting a new one. AndyTheGrump (talk) 10:44, 13 November 2025 (UTC)[reply]

  no wording changes at all, that is the original question verbatim. I'm concerned if I close/reopen it that will be seen as some sort of way to manipulate the outcome. Jmg873 (talk) 13:19, 13 November 2025 (UTC)[reply]

• Bad RfC Attempt to misrepresent sources and change the stance from sceptical to promotional. Polygnotus (talk) 09:18, 9 December 2025 (UTC)[reply]

• YES-ish article needs update: I think the proposed reflects changed attitudes and medical practice better than the existing text, but the current better matches the body and guide WP:LEAD to reflect what the body says. The issue isn’t just a lead change - the issue is the body widely fails WP:MEDRS guidance to use up-to-date evidence. I appreciate that article states years for studies, but the impression of a body using cites to the 1990s or 2004 or 2011 and little or nothing past 2020 is that it’s badly out of date. Maybe just delete a lot of those lines - trim the article down and be less ranty ? Cheers Markbassett (talk) 07:01, 23 January 2026 (UTC)[reply]
• Bad RfC - not neutrally worded. The status quo is misrepresented as "older", with the strong implication it is outdated, which is clearly incorrect and POVy. Needless to say, the status quo is correct. Sirfurboy🏄 (talk) 08:06, 23 January 2026 (UTC)[reply]

Commented out the RfC tag, this is obviously a waste of time. Polygnotus (talk) 11:09, 23 January 2026 (UTC)[reply]

@Polygnotus: please do not do that, see Template:Rfc#Inactive_usage. --Redrose64 🌹 (talk) 13:35, 24 January 2026 (UTC)[reply]