JOSPT Insights Ep 221: Does it matter how you apply spinal manipulative therapy? With Dr Casper Nim
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Apr 14, 2025 
Dr. Casper Nim is an Associate Professor and chiropractor specializing in spinal manipulative therapy (SMT) at the Spine Centre of Southern Denmark. He discusses whether the method of applying SMT affects patient outcomes, highlighting insights from recent research. The conversation explores the differences between acute and chronic spine pain, critiques current research practices, and emphasizes the need for personalized treatments. Nim also shares how clinician confidence and a flexible approach can enhance patient satisfaction in rehabilitation.
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Definition of SMT and Thrust
- Spinal manipulative therapy (SMT) is defined as a high-velocity, low-amplitude thrust to the spine, often involving a cracking sound.
- This distinguishes SMT from general mobilization techniques that lack the thrust component.
SMT's Place Among Interventions
- SMT's effectiveness in spine pain is comparable to other recommended interventions like education and exercise.
- Unlike generalized treatments, SMT emphasizes delivering a specific thrust to a targeted dysfunctional spinal segment.
Reconsidering Acute vs Chronic Pain
- Categorizing spine pain as simply acute or chronic is outdated due to its fluctuating and recurrent nature.
- SMT shows small effects in acute pain but is used similarly across both acute flare-ups and persistent spinal pain.