CurrentUnitedHealthcarePolicy CS076OH.C

Manipulative Therapy (for Ohio Only)

State-specific medical policy governing coverage and medical necessity criteria for manipulative therapies (chiropractic and osteopathic) for UnitedHealthcare members in Ohio. Applies to providers requesting services in Ohio and references Ohio Administrative Code for chiropractic criteria.

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy (for Ohio Only)

Policy CodePolicy CS076OH.C

Change TypeTechnical updates and reference/definition additions

Effective DateSeptember 1, 2025

Next Review DateN/A

Key ActionEvaluate requests in Ohio per Ohio Administrative Code 5160-101 and obtain prior authorization when required by state rules or external criteria.

SourceLink

POLICY UPDATE CHANGES

Removed reference link to the Medical Policy titled Diagnostic Spinal Ultrasonography (for Ohio Only) (retired Oct. 1, 2025) and Neuropsychological Testing Under the Medical Benefit (for Ohio Only) (retired Oct. 1, 2025).

Added reference link to the Medical Policy titled Treatment of Temporomandibular Joint Disorders (for Ohio Only).

Added definition of 'Upledger Technique' to Definitions.

Updated Clinical Evidence and References sections to reflect the most current information.

OhioGeographic applicability

MSDsProven indication

CST/TMJ/ScoliosisUnproven / NMN

98925-98943

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

2Related policy link changes

Coverage Criteria for Manipulative Therapy (Ohio Only)

Coverage and Exclusions for OMT and CMT

Osteopathic Manipulative Therapy (OMT) coverage stance and state-specific chiropractic directive:

OMT Medical Necessity for MSDs: Osteopathic Manipulative Therapy is proven and medically necessary for treating Musculoskeletal Disorders.

See Ohio Administrative Code for chiropractic-specific criteria

Unproven / Not Medically Necessary Indications: OMT is unproven and not medically necessary for non-musculoskeletal disorders, prevention/maintenance/custodial care, craniosacral therapy (including Upledger Technique), temporomandibular joint (TMJ) disorder, scoliosis, and manipulative services that utilize nonstandard techniques (e.g., applied kinesiology, neural organizational technique, NUCCA).

List is not exhaustive; examples provided in policy

Chiropractic Manipulative Therapy: For chiropractic manipulative therapy, medical necessity clinical coverage criteria are as specified in the Ohio Administrative Code, Rule 5160-8-11.

Policy directs providers to state rule for detailed criteria

Coverage-relevant evidence summary

evidence-summary: Multiple systematic reviews and randomized controlled trials show mixed evidence: some trials and reviews report short-term benefits of manual therapy/OMT/spinal manipulation for pain, disability, range of motion, and function across neck, shoulder, elbow, hip, knee, ankle, and headache disorders; however, many studies are small, heterogeneous, have methodological limitations, and lack long-term follow-up.

See cited systematic reviews and RCTs for condition-specific details

Evidence summaries with coverage implications

Evidence-supported scenarios and limitations summarized from RCTs and systematic reviews:

Headache - cervicogenic/migraine/tension-type: Systematic reviews and meta-analyses report that manipulation/mobilization/manual therapy can reduce pain and disability in cervicogenic headache and may reduce migraine days and intensity; evidence quality varies and many studies show only short-term benefit and methodological limitations.

See Núñez-Cabaleiro (2022), Rist et al. (2019), Coelho et al. (2019) and related reviews

Temporomandibular disorders (TMD): Some RCTs and meta-analyses report reductions in TMJ pain and improvements in maximal mouth opening with manual therapy or combined interventions, but studies are small, heterogeneous, and have mixed longer-term results; further high-quality trials are needed.

See Al-Moraissi (2024), Dunning et al. (2024), Lam et al. (2023)

Preventive/Maintenance manipulative care: Evidence for maintenance spinal manipulation is mixed: selected subgroup analyses found fewer days with bothersome low back pain in some patients but overall clinical relevance is limited; preventive/maintenance use lacks sufficient high-quality evidence.

Coverage criteria synthesis (evidence‑based stance)

Summary coverage stance based on reviewed evidence:

SMT for non‑musculoskeletal disorders: High- or acceptable-quality randomized trials found spinal manipulative therapy was not superior to sham for tested non‑musculoskeletal disorders (infantile colic, childhood asthma, hypertension, primary dysmenorrhea, migraine), indicating lack of evidence to support coverage for these indications.

Based on Global Summit systematic review and synthesis

Craniosacral therapy (CST): Multiple systematic reviews and meta-analyses found no reliable, clinically relevant benefit of craniosacral therapy across musculoskeletal and non‑musculoskeletal conditions; evidence is limited by small trials, heterogeneity, and high risk of bias, and therefore does not support routine coverage.

See Amendolara (2024), Ceballos-Laita (2024) and other reviews

Visceral manipulation and OVM: Some small RCTs reported statistically significant improvements for select outcomes (e.g., GERD, constipation with low back pain), but clinical relevance is uncertain and methodological limitations preclude broad coverage recommendations.

Evidence-informed coverage stance

Coverage considerations based on available evidence and specialty guideline positions:

Evidence summary: Evidence for craniosacral therapy is limited and derived from small RCTs, cohort studies, and systematic reviews with risk of bias; while some short-term or preliminary benefits have been reported (e.g., heart rate variability, infantile colic, selected chronic pain outcomes), results are inconsistent and not generalizable.

See Haller et al. (2020), Castejón-Castejón (2019), and systematic reviews

Guideline alignment: Clinical guidelines (ACP/APS, IFOMPT/IOPTP) recommend manipulation/mobilization as part of nonpharmacologic management for certain adolescent/adult spine conditions but advise against spinal manipulation/mobilization in infants and for non‑musculoskeletal pediatric conditions; guideline positions should inform age-specific coverage and sequencing of conservative therapies first.

See ACP/APS and IFOMPT/IOPTP guideline statements

The policy identifies several examples of manipulative therapies and clinical scenarios that are considered unproven or not medically necessary when used outside of musculoskeletal disorders. Specifically, craniosacral therapy (including the Upledger Technique), care directed at temporomandibular joint (TMJ) disorders, and manual/spinal manipulation for scoliosis are listed among indications lacking sufficient evidence to be considered proven or effective. For scoliosis, randomized trials and systematic reviews summarized in the policy report small, heterogeneous studies and methodological limitations that prevent concluding spinal manipulation or nonstandard scoliosis protocols are safe and effective for adolescent or adult idiopathic scoliosis (see Wenxia et al., Langensiepen et al., and multiple reviews cited).

The policy explicitly lists a range of non-musculoskeletal indications for which manipulative therapy is considered unproven or not medically necessary. Examples include asthma, otitis media, infantile colic, internal organ disorders, and other non‑MSK conditions. The document also notes that published peer‑reviewed literature was not identified for certain nonstandard techniques (e.g., applied kinesiology, NUCCA, NOT), reinforcing that non‑MSK uses and nonstandard techniques lack evidentiary support.

The policy concludes there is insufficient evidence to support manipulative therapy when used for prevention, maintenance, or custodial care. Systematic reviews and randomized trials of maintenance care show mixed results: selected subgroups in maintenance trials may report fewer days with bothersome low back pain, but subgroup findings are hypothesis-generating and overall clinical relevance is limited. The policy summarizes that preventive use lacks robust, generalizable evidence and therefore is not established as effective.

Claims that spinal manipulation improves immune function or prevents/treats infectious disease are unsupported. A Global Summit synthesis and a rapid evidence review found no credible evidence that spinal manipulative therapy confers clinically meaningful immune benefits; high- or acceptable-quality RCTs did not show SMT to be superior to sham for conditions studied, and the rapid review found no reliable immunologic effects that translate to patient benefit.

For pediatric care the policy distinguishes musculoskeletal uses from non‑MSK indications and age-related limitations. International guideline statements cited in the policy note that spinal manipulation and mobilization are not recommended for infants and are not recommended for children or adolescents when used for non‑musculoskeletal pediatric conditions (for example, infantile colic, asthma, ADHD, autism spectrum disorder, breastfeeding difficulties, otitis media). Osteopathic manipulative therapy is limited to musculoskeletal disorders; non‑MSK pediatric uses are unproven.

The policy identifies several techniques lacking peer‑reviewed evidence. Published literature was not identified for non‑standard techniques such as applied kinesiology, NUCCA, and neural organizational technique (NOT), and these approaches have no supporting trials in the reviewed evidence. The absence of peer‑reviewed evidence means these techniques are considered unproven within this policy.

Summary of policy document link changes: the policy removed reference links to two retired Ohio‑only medical policies (Diagnostic Spinal Ultrasonography and Neuropsychological Testing Under the Medical Benefit) that were retired effective Oct. 1, 2025, and added a reference link to the Medical Policy titled Treatment of Temporomandibular Joint Disorders (for Ohio Only). The Definitions section was also updated to add the Upledger Technique, and the Clinical Evidence and References sections were updated to reflect current information.

Within the excerpt there are no standalone ‘not medically necessary’ determinations that use formal policy verbiage beyond the general summaries; however, the document repeatedly states that evidence is insufficient for many indications and explicitly identifies numerous uses as unproven or not medically necessary (for example craniosacral therapy, TMJ, scoliosis, non‑MSK disorders, preventive/maintenance care, and nonstandard techniques). In practice, the policy frames many non‑MSK and unsupported technique uses as likely to be considered not medically necessary due to inadequate evidence.

The policy reiterates that preventive manipulative treatment and manipulative therapy for non‑neuromusculoskeletal conditions are not supported by adequate evidence of long‑term clinical benefit. Reviews and trials show methodological limitations and small samples; consequently, preventive or routine maintenance applications and non‑MSK indications lack the evidence base required to justify broad coverage.

Spinal manipulative therapy for a range of non‑musculoskeletal disorders — including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine — was evaluated in multiple randomized trials and systematic reviews. The policy summarizes high‑quality and acceptable‑quality RCTs that found no superiority of SMT over sham for these non‑MSK disorders, indicating limited or negative evidence for SMT in these conditions.

Craniosacral therapy (CST) evidence is consistently limited and of low certainty. Multiple systematic reviews and meta‑analyses (including Amendolara et al. 2024, Ceballos‑Laita et al. 2024, Haller et al. 2020, and critical reviews) conclude that CST does not demonstrate reliable, clinically relevant benefit across the studied musculoskeletal and non‑musculoskeletal conditions. Small RCTs have reported some short‑term or condition‑specific findings (for example in infantile colic), but these trials are frequently at high risk of bias and not generalizable. The policy therefore states CST evidence is insufficient and CST should not replace conventional medical care.

Procedure and Billing Codes

Referenced Procedure/HCPCS/CPT Codesmixed

98925	Osteopathic manipulative treatment (OMT); 1-2 body regions involved.
98926	Osteopathic manipulative treatment (OMT); 3-4 body regions involved.
98927	Osteopathic manipulative treatment (OMT); 5-6 body regions involved.
98928	Osteopathic manipulative treatment (OMT); 7-8 body regions involved.
98929	Osteopathic manipulative treatment (OMT); 9-10 body regions involved.
98940	Chiropractic manipulative treatment (CMT); spinal, 1-2 regions.
98941	Chiropractic manipulative treatment (CMT); spinal, 3-4 regions.
98942	Chiropractic manipulative treatment (CMT); spinal, 5 regions.
98943	Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions.
S8990	Physical or manipulative therapy performed for maintenance rather than restoration.

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Provider Actions, Prior Authorization, and Documentation

Prior Authorization

Prior authorization / medical necessity governed by Ohio rules

Prior authorization and medical necessity determinations for services described in this policy are governed by Ohio rules. Any requests for services identified as unproven, or those subject to coverage or quantity limits, will be evaluated for medical necessity under Ohio Administrative Code (OAC) 5160-101. For chiropractic manipulative therapy, refer to OAC Rule 5160-8-11 for state‑specific clinical coverage criteria.

Ohio Administrative Code 5160-101 governs medical necessity review for services stated as unproven or limited
See OAC Rule 5160-8-11 for chiropractic manipulative therapy criteria

Note

Prior authorization not specified in excerpt

The source excerpt does not specify a distinct list of procedure codes that require prior authorization. Providers should follow applicable benefit plan, federal/state (OAC), and contractual requirements to determine whether prior authorization is required for a given service.

Listing of codes in this policy is for reference only and does not imply PA requirements or coverage

Definitions and Terms

Definition — Manipulative Therapy (compact key/value)

TermManipulative Therapy

DefinitionTherapeutic manual application of pressure or force in which the practitioner moves or manipulates one or more parts of the patient's body to achieve and maintain patient health; includes OMT/OMM, chiropractic care, manual therapy, and examples such as physical therapy and massage.

Primary useTo treat structural and functional issues in bones, joints, tissues, and muscles; used alone or as part of broader evaluation and treatment.

Definition — Musculoskeletal Disorders (MSDs)

TermMusculoskeletal Disorders (MSDs)

DefinitionInjuries or conditions originating from joints, muscles, ligaments, discs, or other soft tissues in the spine or limbs that produce clinically relevant symptoms (e.g., pain, numbness) and functional limitations.

Background and Evidence Summary

Context for the evidence summaries: the policy synthesizes findings from multiple systematic reviews and randomized controlled trials to inform the coverage stance. For headaches, several systematic reviews and meta‑analyses are cited showing that manipulation and mobilization may reduce pain and disability in cervicogenic headache and may have preliminary benefit in migraine, but study quality and heterogeneity limit definitive conclusions. These evidence summaries support the policy’s distinction between musculoskeletal indications (supported) and many non‑MSK indications (unsupported).

Detailed evidence summaries: the policy references multiple RCTs and meta‑analyses across clinical domains. For headache disorders, systematic reviews (Núñez‑Cabaleiro; Rist et al.; Coelho et al.) and overviews report mixed but sometimes favorable short‑term outcomes for manipulation/mobilization. For temporomandibular disorders (TMD), network meta‑analysis and recent RCTs (Al‑Moraissi 2024; Dunning et al. 2024) demonstrated some reductions in pain and improved mouth opening with manual therapy or combined approaches, but limitations (small trials, heterogeneity, potential biases) mean further high‑quality trials are needed before broader coverage changes.

Evidence synthesis and meta‑analyses informing policy stance: syntheses such as the Global Summit review of SMT for non‑MSK disorders and multiple CST meta‑analyses consistently found either no effect or effects limited by bias, heterogeneity, and imprecision. The policy uses these aggregated findings to justify cautious coverage positions for non‑MSK indications and for CST, highlighting the need for larger, rigorous RCTs to change current conclusions.

Evidence‑informed stance and guideline concordance: the policy aligns its coverage considerations with specialty guideline positions. For low back and neck pain, ACP/APS supports nonpharmacologic therapies including manipulation for appropriate patients; IFOMPT/IOPTP guidance restricts manipulation in infants and for non‑musculoskeletal pediatric conditions. The policy therefore supports use of OMT/CMT for musculoskeletal disorders while treating non‑MSK and unsupported techniques conservatively given the current evidence limitations.

Revision History and Policy Changes

2025-10-01related_policies_removed

Removed reference links to the Medical Policies 'Diagnostic Spinal Ultrasonography (for Ohio Only)' and 'Neuropsychological Testing Under the Medical Benefit (for Ohio Only)' when those policies were retired.

2025-09-01related_policy_added

Added a reference link to the Medical Policy 'Treatment of Temporomandibular Joint Disorders (for Ohio Only)'.

2025-09-01definition_added

Added a definition for the 'Upledger Technique' to the Definitions section.

Policy Summary

PayerUnitedHealthcare

PolicyManipulative Therapy (for Ohio Only)

Policy CodePolicy CS076OH.C

Change TypeTechnical updates and reference/definition additions

Effective DateSeptember 1, 2025

Next Review DateN/A

Key ActionEvaluate requests in Ohio per Ohio Administrative Code 5160-101 and obtain prior authorization when required by state rules or external criteria.

SourceLink

On This Page

See Eklund et al. (2018, 2019) and Chow et al. (2021)

Non-musculoskeletal disorders: Current high-quality trials do not show benefit of spinal manipulative therapy for non-musculoskeletal disorders (e.g., infantile colic, childhood asthma, hypertension, primary dysmenorrhea, migraine); available trials are limited and do not support general use for these indications.

See Global Summit synthesis (Côté et al. 2021) and related critiques

Examples include Eguaras (GERD) and Boas Fernandes (constipation with LBP)

Neuroimmunoendocrine claims: There is no credible evidence that spinal manipulation confers or enhances immunity; use for prevention or treatment of infectious diseases is unproven and should not be covered for that purpose.

Based on Kawchuk et al. (2020) rapid review

Benefit terms and state/contractual rules govern PA applicability

Denial Risk

Denial triggers — unproven indications

Services for indications lacking sufficient evidence may be denied as not medically necessary. Examples called out in the evidence summary include craniosacral therapy, TMJ/temporomandibular joint disorder treatment when manipulation is proposed, scoliosis (manipulative approaches), preventive/maintenance/custodial care, non‑musculoskeletal disorders (e.g., asthma, otitis media, infantile colic), and manipulative techniques described as nonstandard (e.g., applied kinesiology, NUCCA).

Unproven / not medically necessary examples: craniosacral therapy, TMJ manipulation, scoliosis, preventive/maintenance/custodial care, non‑MSK disorders
Nonstandard techniques (e.g., applied kinesiology, NUCCA) are considered unproven

Note

No explicit administrative authorization or denial triggers specified in excerpt

The excerpts do not provide explicit operational instructions for administrative authorization or denial triggers beyond the evidence summaries and references to governing rules. Coverage decisions must instead reference applicable federal, state (OAC), or contractual benefit terms and be implemented according to plan-specific prior authorization processes.

No explicit administrative authorization/denial workflow described in the excerpt
Use plan-specific PA/UR procedures in conjunction with OAC and contractual terms

Denial Risk

Preventive manipulative treatment — evidence insufficient

There is insufficient evidence to support the use of manipulative therapies (including maintenance or preventive spinal manipulation) for preventive, maintenance, or custodial care. Some trials of maintenance care suggest potential benefit in selected subgroups, but findings are limited, inconsistent, or of uncertain clinical significance.

Insufficient evidence to conclude effectiveness of manipulative therapy for prevention/maintenance/custodial care
Maintenance care trials show subgroup signals but are limited by methodological issues and inconsistent clinical relevance

Denial Risk

Evidence insufficiency risk — interventions lacking strong evidence may be denied

Overall evidence insufficiency is a recurring risk for coverage. For many non‑musculoskeletal and several complementary manipulative interventions (e.g., visceral manipulation, craniosacral therapy, nonstandard techniques), the literature is limited, of low quality, or shows no benefit versus sham, placing these services at higher risk for denial.

High-quality RCTs generally show no benefit of SMT for non‑musculoskeletal disorders
Craniosacral therapy and many visceral/alternative manipulations lack robust evidence and may be denied

Prior Authorization

Compliance with governing requirements

Coverage decisions must comply with federal, state (OAC), and contractual benefit requirements. In the event of conflict, those governing requirements take precedence over this policy. UnitedHealthcare may use InterQual® criteria, ASAM criteria for substance use, and approved UnitedHealthcare policies/guidelines (as applicable and per OAC) when administering benefits.

In case of conflict, federal/state (OAC)/contractual terms govern coverage
UnitedHealthcare uses InterQual® (and ASAM for SUD) as primary criteria tools

Billing Rule

Coding and documentation note

Listing of CPT/HCPCS (or other) codes in this policy is for reference only and does not guarantee coverage or payment. Benefit plan terms, federal/state (OAC), and contractual requirements determine coverage and reimbursement. See related policy references for coding clarifications (e.g., CPT 97140 manual therapy guidance).

Code list is not an indication of coverage or reimbursement eligibility
See Habilitation and Rehabilitation Therapy policy (Ohio Only) for CPT 97140 guidance

Documentation Required

No specific documentation requirements provided in excerpt

The policy excerpt does not prescribe a single, exhaustive set of documentation requirements for prior authorization. Instead, documentation expectations should align with medical necessity review under OAC and plan‑specific UR/PA processes. Absence of explicit documentation rules in the excerpt means providers must follow state and payer operational guidance.

No specific, detailed documentation checklist is provided in the excerpt
Follow OAC guidance and UnitedHealthcare PA/UR instructions for required documentation

Documentation Required

Recommended documentation elements for medical necessity review

Recommended documentation elements include clear diagnostic rationale, description of the specific manual/manipulative technique proposed, targeted body region(s), indication and goals of therapy, prior conservative treatments tried (and responses), planned frequency and duration (number of sessions), objective outcome measures, and follow‑up or reassessment plans.

Diagnosis and clinical indication tied to evidence-based rationale
Specific technique and targeted regions (e.g., OMT, CMT, SMT, CST)
Prior conservative therapy and response (exercise, education, guideline therapies)
Planned frequency/duration (session count and interval) and objective outcome measures

Documentation Required

Clinical documentation expectations — note evidence limitations

Clinical documentation should acknowledge the limited sample sizes, short follow‑up durations, methodological limitations, and variable risk‑of‑bias reported across the literature. When citing evidence to support treatment, include trial quality, sample size, follow‑up length, and relevance to the member's clinical presentation.

Note small sample sizes, incomplete follow‑up, and risk of bias in cited studies
Reference whether supportive studies are RCTs, cohort studies, or case series and their applicability to the patient

Documentation Required

Suggested documentation elements — objective measures and session details

Suggested documentation elements for treatments that claim benefit include a clear indication, number of sessions planned and delivered, objective measures of improvement (e.g., pain scores, function, range of motion, validated questionnaires), and documented outcomes and follow‑up. For maintenance or preventive plans, document rationale, expected benefit, and supporting high‑quality evidence if available.

Indication and expected clinical benefit
Session counts and treatment schedule
Objective outcome measures and documented response over time
Rationale and evidence basis for maintenance/preventive use

Documentation Required

Documentation and governance — reference governing requirements in decisions

When determining coverage or issuing authorizations/denials, reference and document the controlling federal, state (OAC), or contractual benefit terms. Use InterQual® criteria or other approved UnitedHealthcare tools where applicable, and record which criteria or policy was applied in the decision rationale.

Cite federal/state (OAC)/contractual terms that govern the member's plan
Document which utilization criteria (e.g., InterQual®) or policy language informed the decision

Prior Authorization

Conservative therapy before ongoing manipulation — recommend guideline first-line care

Conservative, guideline‑based therapies (exercise, education, self‑care, and other nonpharmacologic first‑line measures) are recommended as first‑line before ongoing manual or manipulative interventions. Randomized trials and systematic reviews indicate that exercise and other conservative treatments can yield outcomes comparable to manipulation for some conditions; document prior conservative care and response when requesting manipulative services.

Recommend exercise, education, and guideline-based nonpharmacologic care before manipulation
Document prior conservative treatment attempts and clinical response as part of medical necessity review

ContextMSDs are the primary proven indication for OMT per this policy.

Definition — Upledger Technique / Craniosacral therapy (CST)

TermUpledger Technique / Craniosacral therapy (CST)

DefinitionA noninvasive, light‑touch whole‑body osteopathic technique that detects and works with craniosacral rhythms to influence cerebrospinal fluid flow and autonomic function; alleged uses include treatment for a variety of musculoskeletal and non‑MSK conditions.

Evidence summarySystematic reviews and meta-analyses report limited, low‑quality evidence: small short‑term HRV effects reported but overall insufficient evidence for diagnostic reliability or broad clinical efficacy.

Definition — Upledger Technique (added definition reference)

TermUpledger Technique

DefinitionA complementary, light‑touch, whole‑body treatment technique developed by John E. Upledger that works with the craniosacral system to support the central nervous system and improve coping and self‑care.

Policy noteAdded to Definitions in the Oct 1, 2025 policy revision.

Definition — Osteopathic manipulative treatment (OMT)

TermOsteopathic manipulative treatment (OMT)

DefinitionHands‑on manual techniques delivered by osteopathic practitioners to diagnose, treat, and prevent illness or injury by moving muscles and joints using stretching, gentle pressure, and resistance; used alone or with exercise in trials assessing pain, disability, and range of motion.

Clinical roleOMT is considered proven and medically necessary for Musculoskeletal Disorders per the policy.

Definition — Scoliosis specific exercises with side-alternating whole body vibration (sWBV)

TermScoliosis-specific exercises (SSE) with side‑alternating whole body vibration (sWBV)

DefinitionA home‑based exercise program performed on a side‑alternating whole body vibration platform combined with scoliosis‑specific exercises (standing, sitting, kneeling), evaluated over six months in girls with adolescent idiopathic scoliosis (AIS).

Key outcomeIn the cited RCT the major curve decreased by mean −2.3° in the sWBV group versus 0.3° in controls; results limited by small sample size and subgroup findings.

Definition — Cervicogenic headache (CH)

TermCervicogenic headache (CH)

DefinitionHeadache attributed to neck structures; studied with manual therapy interventions including spinal manipulation, mobilization, and muscle techniques which may reduce pain and disability in some trials.

Evidence noteSystematic reviews report short‑term pain and disability benefits from combined manual therapies, but study quality and heterogeneity limit conclusions.

Definition — Temporomandibular disorder (TMD)

TermTemporomandibular disorder (TMD)

DefinitionDisorders affecting the temporomandibular joint and related structures; outcomes studied include pain intensity, pressure pain thresholds, and maximal mouth opening.

Evidence noteSome trials and meta‑analyses report reduced TMJ pain and improved mouth opening with manual therapy versus controls, but studies are small and heterogeneous.

Definition — Maintenance care (MC)

TermMaintenance care (MC)

DefinitionRepeated or ongoing manipulative treatment aimed at preventing recurrence of symptoms (tertiary prevention) after an initial response to care.

Evidence noteTrials show mixed results with subgroup benefits in selected psychological profiles; overall clinical relevance and generalizability remain limited.

Definition — Neuroimmunoendocrine effects (SMT claims)

TermNeuroimmunoendocrine effects (SMT claims)

DefinitionProposed physiological effects of spinal manipulation on immune or neuroendocrine biomarkers that have been cited to claim enhanced immunity or infection prevention.

Evidence noteRapid reviews found no credible scientific evidence that spinal manipulation confers or enhances immunity; use for treating or preventing infectious diseases is unproven.

Definition — Craniosacral Therapy (CST) (definition and measured outcomes)

TermCraniosacral Therapy (CST)

DefinitionA manual therapy technique aiming to influence cranial rhythmic impulse and autonomic function through light touch on the skull and spine; evaluated for effects on heart rate variability, pain, and conditions such as infantile colic and migraine.

Measured outcomesReported short‑term increase in parasympathetic activity (HF HRV SMD −0.46) in one meta‑analysis; systematic reviews report unreliable diagnostic reliability and insufficient high‑quality evidence for clinical efficacy.

Definition — Non-standard manipulative techniques (applied kinesiology, NUCCA, neural organization technique)

TermNon‑standard manipulative techniques

DefinitionManipulative approaches without identified peer‑reviewed evidence in this review, including applied kinesiology, National Upper Cervical Chiropractic Association (NUCCA) technique, and Neural Organizational Technique (NOT).

Policy implicationPublished peer‑reviewed literature supporting these techniques was not identified; they are considered unproven in the policy context.

Background summary: Manipulative therapy encompasses hands‑on manual techniques used to address structural and functional problems in the musculoskeletal system. The policy emphasizes that while manipulative therapies (OMT/CMT/mobilization) can be effective for certain musculoskeletal conditions, the evidence base varies by condition and many non‑MSK uses are unproven. Clinical trial evidence cited includes systematic reviews and RCTs across headache, spine, and extremity disorders with heterogeneity in quality and duration of follow‑up.

2025-09-01supporting_info_updatedLatest

Updated the Clinical Evidence and References sections to reflect the most current information and archived previous policy version CS076OH.B.