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Clinical Compass The Clinical Compass (CCGPP) exists to translate existing knowledge into effective, evidence - based chiropractic practice.

The Clinical Compass is powered by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). Our mission is to gather and evaluate existing evidence-based practice information; to facilitate the development of new information where existing evidence is lacking; and to distribute and assist in implementation of evidence-based practice information that is relevant to the chiropractic profession.

Does every patient with neck pain need imaging?According to these best-practice recommendations: No.The authors make an ...
10/23/2026

Does every patient with neck pain need imaging?

According to these best-practice recommendations: No.

The authors make an important point about diagnostic imaging:

It should be condition-specific and based on the patient's history, examination, and established clinical guidelines.

It should not be based on:

❌ Philosophy
❌ Routine office policy
❌ Financial considerations

And not every patient presenting for chiropractic care requires an X-ray. ymmt-article-p635

The recommendations also caution against imaging simply to identify spinal degeneration, noting that degenerative changes are often present in people without pain. ymmt-article-p635

The question shouldn't be:

"Do I X-ray my neck pain patients?"

It should be:

"Will imaging meaningfully contribute to clinical decision-making for this patient?"

What does best-practice neck pain care actually include?The recommendations from Whalen et al. cover a lot of ground, bu...
10/21/2026

What does best-practice neck pain care actually include?

The recommendations from Whalen et al. cover a lot of ground, but five themes stand out:

1️⃣ Use a multimodal approach.
Manipulation or mobilization may be part of care—but so are exercise, education, activity, and self-management.

2️⃣ Start with a trial of care.
Treatment shouldn't begin as an open-ended commitment.

3️⃣ Measure and reassess.
Pain matters, but so do function, disability, and the patient's ability to participate in daily life.

4️⃣ Use imaging when clinically indicated.
Imaging decisions should be driven by the clinical presentation—not routine office protocols.

5️⃣ Work toward patient self-reliance.
As patients improve, the emphasis should increasingly shift toward active care and independent management.

The common thread?

Evidence-informed care should be responsive to the individual patient—not performed on autopilot.

We'll unpack each of these throughout the month.

What does best-practice chiropractic care for neck pain actually look like?This month, we're taking a closer look at Bes...
10/19/2026

What does best-practice chiropractic care for neck pain actually look like?

This month, we're taking a closer look at Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain by Whalen et al.

This wasn't a trial testing whether one treatment works better than another. Instead, the authors set out to develop practical, evidence-informed recommendations for the chiropractic management of adults with neck pain.

A steering committee reviewed current clinical practice guidelines and supporting literature, then used a modified Delphi process to reach expert consensus.

📚 56 chiropractors
📋 50 statements and concepts
🤝 Consensus reached on all statements

And the recommendations extend far beyond spinal manipulation.

They address the entire clinical encounter—from history and examination to informed consent, treatment planning, reassessment, referral, and discharge.

Throughout October, we'll break down what these recommendations mean for evidence-informed chiropractic practice.

Because best practice isn't just about what treatment you provide. It's about the entire process of care.

Behind every paper we translate are researchers doing the work to move the evidence forward.As we close out this month's...
09/28/2026

Behind every paper we translate are researchers doing the work to move the evidence forward.

As we close out this month's Research Translation series, we'd like to recognize and thank the authors of our featured systematic review:

Alec L. Schielke, DC
Robert J. Trager, DC
Joel M. Stevans, DC, PhD
Morgan R. Price, DC
Ronald D. Wilcox, DC
Sheryl A. Walters, MLS
Clinton J. Daniels, DC, MS

Their work gave us the opportunity to explore important questions about spinal manipulative therapy for older adults—from comparative effectiveness and clinical significance to evidence certainty, patient selection, and the limitations of the current research.

Research like this doesn't give us a simple answer to every clinical question.

It gives us something equally valuable: better evidence to inform better questions, better conversations, and better clinical decisions.

Thank you to the authors for advancing the evidence around conservative spine care for older adults—and for giving our profession more to learn from, critically evaluate, and build upon.

What should patients know?Getting older doesn't automatically mean hands-on care is off the table.This month's featured ...
09/25/2026

What should patients know?

Getting older doesn't automatically mean hands-on care is off the table.

This month's featured systematic review suggests that spinal manipulative therapy may be one reasonable conservative treatment option for appropriately selected older adults with certain chronic spinal conditions.

But perhaps the bigger takeaway is this:

There may be more than one evidence-informed way to manage chronic spine pain.

SMT, exercise, physical therapy, education, home exercise, and other conservative approaches don't necessarily need to compete for a single “best” treatment.

Instead, treatment decisions can consider what matters to the individual patient—their clinical presentation, overall health, goals, preferences, potential risks, and response to care.

For patients, that means asking questions, understanding the available options, and participating in decisions about your care.

For clinicians, it means making space for those conversations.

As we wrap up this month's Research Translation series, we'd love to hear from you:

How can clinicians better involve older adults in choosing between evidence-informed conservative treatment options?

Because patient-centered care isn't simply about choosing an evidence-informed treatment.

It's about choosing it with the patient.

Before we overstate the results…There are reasons to be encouraged by this systematic review.There are also important re...
09/23/2026

Before we overstate the results…

There are reasons to be encouraged by this systematic review.

There are also important reasons to be cautious.

The review included:

7 randomized controlled trials
1,226 participants
Evidence certainty ranging from very low to moderate

When interpreting the findings, we also need to consider:

• The relatively small number of available trials
• Small sample sizes for some comparisons
• Imprecision in the estimates
• Risk of bias
• Clinical heterogeneity across populations, conditions, interventions, and outcomes

These limitations don't mean the findings should be dismissed.

But they do affect how confidently we can apply them.

That's an important part of responsible research translation—especially when the findings appear favorable.

It's easy to critically appraise research when we disagree with the results. Evidence-informed practice requires us to apply that same scrutiny when the findings support what we already believe.

So, is the evidence promising?

Yes.

Is it definitive?

Not yet.

More high-quality research in older adults is needed to better understand which patients are most likely to benefit, which approaches are most appropriate, and how those outcomes compare with other conservative treatment options.

What should clinicians care about?This systematic review doesn't tell us that spinal manipulative therapy is the best tr...
09/21/2026

What should clinicians care about?

This systematic review doesn't tell us that spinal manipulative therapy is the best treatment for older adults with chronic spinal conditions.

And it doesn't need to.

Across the included trials, SMT generally produced outcomes that were comparable to—and in some instances modestly better than—other conservative approaches.

That supports a more practical clinical takeaway:

SMT can be considered one conservative treatment option for appropriately selected older adults, in the absence of contraindications.

Not because it consistently outperformed exercise, physical therapy, education, or other conservative interventions.

But because evidence-informed care doesn't require every reasonable treatment to prove itself superior to every alternative.

Instead, clinicians can consider:

• The patient's clinical presentation
• Goals and preferences
• Comorbidities and potential risks
• Precautions and contraindications
• Available evidence
• Response to care

From there, the question becomes less:

“Is SMT better than everything else?”

And more:

“Is SMT a reasonable evidence-informed option for this patient?”

That's an important distinction.

SMT doesn't need to outperform every other conservative treatment to have a place among the available options.

Does one conservative treatment have to “win”?Not necessarily.One of the most useful takeaways from this systematic revi...
09/18/2026

Does one conservative treatment have to “win”?

Not necessarily.

One of the most useful takeaways from this systematic review is that spinal manipulative therapy can sit alongside other conservative approaches as a reasonable treatment option for some older adults.

Across the included studies, SMT was often compared with other active interventions—including exercise, physical therapy, education, and home exercise—and frequently produced comparable outcomes.

That shifts the clinical conversation.

Instead of asking:

“Which treatment is best?”

We can ask:

“Which evidence-informed option best fits this patient?”

The answer may depend on the patient's clinical presentation, goals, preferences, comorbidities, potential risks, access to care, and response to treatment.

And in many cases, care doesn't have to be either/or. Conservative approaches can be combined or adapted as a patient's needs change.

Evidence-informed care isn't a competition between treatments or professions.

It's about understanding the reasonable options available and using clinical expertise and shared decision-making to determine the best path forward for the individual patient.

The goal isn't for a treatment to win. The goal is for the patient to benefit.

Statistically significant. But clinically meaningful?Those aren't always the same thing.In one trial included in this sy...
09/16/2026

Statistically significant. But clinically meaningful?

Those aren't always the same thing.

In one trial included in this systematic review, older adults with lumbar spinal stenosis who received manual therapy + individualized exercise showed greater improvement in some functional outcomes compared with medical care or group exercise.

The difference was statistically significant.

But there was an important caveat:

The between-group difference did not reach the reported threshold for a minimal clinically important difference (MCID).

Why does that matter?

Statistical significance helps us determine whether an observed difference is unlikely to be explained by chance alone.

Clinical significance asks a different question:

Was the difference large enough to actually matter to the patient?

A result can be statistically significant without producing a change that patients would perceive as meaningful in their everyday lives.

That doesn't make the finding irrelevant. It changes how we interpret it.

When evaluating research, don't stop at the p-value.

Ask:

How large was the effect? And was it meaningful enough to matter to the patient?

Because evidence-informed care isn't just about identifying differences.

It's about understanding whether those differences are likely to make a meaningful difference in someone's life.

“Not superior” doesn't mean “not effective.”It's an important distinction—and one that can easily get lost when interpre...
09/14/2026

“Not superior” doesn't mean “not effective.”

It's an important distinction—and one that can easily get lost when interpreting research.

Many of the studies in this systematic review weren't comparing spinal manipulative therapy with no treatment.

They were comparing SMT with other active conservative interventions, including exercise, rehabilitation, and physical therapy approaches.

So when two treatments produce similar outcomes, that doesn't necessarily mean neither treatment worked.

It may mean both are reasonable treatment options.

This is the difference between asking:

“Did SMT outperform the comparator?”

and

“Did SMT perform comparably to another established conservative approach?”

Those are very different research questions.

Comparative effectiveness research helps us understand how available treatment options perform relative to one another. When outcomes are similar, clinical decisions may then incorporate other important factors—such as the patient's presentation, preferences, goals, potential risks, access to care, and response to treatment.

Evidence-informed practice isn't always about finding a single “winner.”

Sometimes the evidence tells us we have more than one reasonable path forward.

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