Effectiveness of Chiropractic Adjustment on Low Back Pain Among the University Students: A Systematic Review

Low back pain (LBP) is a major musculoskeletal complaint among university students, primarily driven by prolonged sitting, poor posture, and academic-related physical strain. Chiropractic adjustment—most commonly delivered as high-velocity, low-amplitude spinal manipulative therapy (SMT)—and traditional physical therapy are widely used conservative treatments, yet their comparative effectiveness remains uncertain. To evaluate and compare the effectiveness of chiropractic adjustment and traditional physical therapy in reducing pain and improving functional mobility among adults with nonspecific LBP, with relevance to university-aged populations. A systematic search was conducted across PubMed, Springer, Scopus, Google Scholar, and ResearchGate database using PICO-based Boolean terms. Eligible studies included adults ≥18 years with nonspecific LBP; interventions involving chiropractic SMT or physiotherapy; validated outcome measures such as VAS, NRS, ODI, and RMDQ; and randomized controlled trials, systematic reviews, or meta-analyses. Eighteen studies met the inclusion criteria and were qualitatively synthesized. Evidence showed that SMT—particularly HVLA techniques—provided significant short-term reductions in pain intensity. However, most included studies reported comparable long-term outcomes between chiropractic adjustment and physiotherapy in pain reduction, disability improvement, and functional mobility. Adverse events were infrequent, mild, and transient, with no serious complications reported. Chiropractic adjustment is a safe and effective conservative approach for nonspecific LBP, offering clinical outcomes largely equivalent to physiotherapy. Both modalities provide meaningful benefits for university-aged individuals and support personalized treatment selection.