Clinical Research
Articles &
Reference Literature
Reference Literature
Peer-reviewed research supporting the clinical approaches used in practice — spinal manipulation, dry needling, acupuncture, and trunk stability training. Updated as notable literature is published.
Spinal Manipulation
Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: The PACBACK Randomized Clinical Trial
A large factorial RCT enrolling over 1,000 adults with acute or subacute low back pain at moderate-to-high risk of chronicity. Participants received spinal manipulation therapy, supported self-management, a combined approach, or guideline-based medical care over 8 weeks, with 1-year follow-up. One of the most rigorous trials of spinal manipulation published to date — directly addressing outcomes in the population most at risk of chronic disability.
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PMID: 41460638
The Effectiveness of Spinal Manipulative Therapy in Treating Spinal Pain Does Not Depend on the Application Procedures
A systematic review and network meta-analysis evaluating whether the specific application procedures of spinal manipulative therapy — target segment, thrust type, or spinal region — significantly affect outcomes in pain and disability. Results indicate that SMT produces consistent clinical improvements regardless of technique specifics, supporting its use across a variety of clinical presentations and provider styles.
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JOSPT 2025
Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations
A comprehensive review of chiropractic research trends from 1972 through 2024, paired with an analysis of current clinical practice guideline recommendations for spinal manipulative therapy. Identifies SMT as a recommended primary or adjunct therapy for spine pain across multiple major clinical guidelines, and documents the evolution of the evidence base over five decades.
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PMC 2024
Dry Needling & Acupuncture
Dry Needling of the Gluteus Medius Muscle, Combined with Standard Care, for Chronic Low Back Pain — A Pilot Randomized Sham-Controlled Trial
A randomized sham-controlled trial examining the addition of gluteus medius dry needling to standard active physical therapy in patients with chronic nonspecific low back pain. The intervention group demonstrated improvements in pain and function beyond physical therapy alone, supporting dry needling as a clinically meaningful adjunct treatment — particularly when gluteal weakness and trigger points are identified.
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Published 2025
Comparative Efficacy of Acupuncture for Chronic Low Back Pain: A Network Meta-Analysis
A network meta-analysis of 63 randomized controlled trials (n=9,454) evaluating acupuncture approaches for chronic nonspecific low back pain. Individualized acupuncture and electroacupuncture combined with lumbar-pelvic training demonstrated significant reductions in pain intensity exceeding the minimal clinically important difference threshold. Multimodal approaches consistently outperformed single-modality treatment.
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PROSPERO 2024
Clinical Efficacy of Acupuncture Therapy Combined with Core Muscle Exercises in Treating Patients with Chronic Nonspecific Low Back Pain
A systematic review and meta-analysis examining the combination of acupuncture with core stabilization exercise in chronic nonspecific LBP. The combined approach demonstrated superior outcomes in pain reduction and functional improvement compared to exercise alone — reinforcing the clinical rationale for integrating needling techniques with structured rehabilitation programming.
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DOI: 10.3389/fmed.2024
Trunk Stability & Core Control
Finite Element Investigation of the Intrinsic Stiffness Contribution of Intra-Abdominal Pressure in a Transient Spine and Trunk Model
A 2025 finite element modeling study examining how intra-abdominal pressure contributes to spinal stiffness under transient loading conditions. Findings highlight that IAP's stabilizing role becomes particularly critical when external mechanical loads shift rapidly — reinforcing its importance not just in controlled lifting, but in the unpredictable real-world demands of daily activity and athletic performance.
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PMID: 40614524
Impact of Diaphragm-Strengthening Core Training on Postural Stability in High-Intensity Squats
A 2024 study examining the effect of diaphragmatic strengthening within a structured core training program on postural stability during high-intensity squats. The diaphragm-focused group demonstrated superior improvements in diaphragm thickness, respiratory pressure, and postural stability compared to traditional core training — quantifying the clinical value of breathing mechanics in performance training.
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DOI: 10.3390/life14121612
Lumbar Spine Stability Can Be Augmented with an Abdominal Belt and/or Increased Intra-Abdominal Pressure
The landmark study by Cholewicki, McGill and colleagues establishing the quantified relationship between intra-abdominal pressure and lumbar spine stiffness. Demonstrated that IAP increases trunk stiffness by 21–42% in flexion and 16–30% in lateral bending — providing the biomechanical foundation for core pressurization as a spine injury prevention strategy. Still the most-cited reference on the topic.
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PMID: 10552322
Note: Articles linked here are provided for educational and reference purposes. Dr. Ray does not receive compensation for any article recommendations. Links to PubMed, JOSPT, and other journals are provided as direct access to peer-reviewed research. Full text may require institutional access or journal subscription for some articles.