The University of Johannesburg (UJ), in collaboration with cross-institutional researchers, has published the first comprehensive national mapping of South Africa’s grey literature on spinal manipulation therapy (SMT) for headaches, uncovering 25 years of previously under-recognised clinical evidence involving 921 patients.
The scoping review, published in BMC Complementary Medicine and Therapies, screened 801 South African postgraduate dissertations and identified 25 eligible master’s studies conducted over a 25-year period. Despite being largely unpublished in mainstream indexed journals, the consolidated findings reveal consistent and clinically meaningful reductions in headache pain and disability following chiropractic spinal manipulation therapy.
Across the analysed studies, mean pain scores decreased by as much as 6.39 points on the Numerical Pain Rating Scale, a substantial reduction in reported pain intensity. Disability scores improved by up to 47.74 points on the Headache Disability Index, reflecting notable gains in daily functioning and quality of life. In addition to patient-reported outcomes, objective clinical measures such as cervical range of motion and pressure pain thresholds showed improvement in most studies.
Importantly, the findings were consistent with outcomes reported in published international clinical trials and observational research. The review further found that chiropractic spinal manipulation therapy combined with other non-pharmacological interventions yielded more significant improvements than medication-only approaches, highlighting the potential value of conservative, integrative headache management strategies.
Headache disorders remain among the leading causes of disability worldwide, with significant social and economic costs. In South Africa, where access to chiropractic services within public healthcare remains limited and unevenly distributed, strengthening the local evidence base is particularly important for informing equitable healthcare planning.
The study, titled “Mapping evidence of spinal manipulation therapy for headaches in South Africa: a scoping review of grey literature” (2025), analysed postgraduate research conducted at the only two South African institutions offering chiropractic qualifications on the African continent. Using a structured scoping review methodology, researchers systematically searched university repositories and archives to capture master’s studies focusing on tension-type headaches, migraines and cervicogenic headaches.
Dr Fatima Ismail, Head of the Department of Chiropractic at UJ, explains that the findings demonstrate the value of consolidating local clinical research that has long existed outside conventional indexing systems. “For many South African communities who do not currently have access to chiropractic services within public healthcare, this review presents local evidence on spinal manipulation therapy and highlights the opportunity to integrate evidence-informed musculoskeletal conservative care into broader health systems. For academics and students, it provides a foundation for more rigorous and collaborative research. For health authorities and professional bodies, it offers an accessible synthesis of national evidence that can inform policy dialogue and clinical guidelines,” she says.
The review also identifies methodological strengths within postgraduate research while acknowledging limitations within the Global South. As with most grey literature, variability in study design, sample sizes and reporting standards means findings should be interpreted within the context. By valuing grey literature, the study challenges the marginalisation of locally generated knowledge and highlights the importance of inclusive evidence systems that reflect diverse healthcare realities. Nonetheless, the consistency of both subjective and objective improvements across studies strengthens confidence in the overall trend.
Co-author Dr Katie Pohlman notes that pooling the grey literature significantly enhances the visibility of South African scholarship within global evidence systems. “A significant amount of South African research on spinal manipulation for headaches has been produced at postgraduate level. By pooling these findings, we contribute to the broader scientific conversation and help shape evidence-based practice.”
Co-author Dr Keseri Padayachy adds that the review reflects a broader responsibility within the academic community. “This study is about visibility and accountability. It brings previously overlooked research into view and reflects the collective commitment of institutions and professional bodies, including collaborations between UJ, Durban University of Technology, Palker University (USA), Health Sciences University (UK) and the Chiropractic Association of South Africa, to ensure that our scholarship strengthens patient care and guides future inquiry.”
Professor Annie Temane, Executive Dean of the Faculty of Health Sciences at UJ, concludes that the project aligns directly with the University’s strategic vision. “Headache disorders affect productivity, well-being and quality of life. Strengthening the evidence base for conservative management options supports more sustainable and patient-centred healthcare, particularly within resource-constrained environments. By transforming isolated postgraduate theses into accessible cumulative knowledge, the review positions South African research more prominently within global evidence discussions, while reinforcing the case for integrative, evidence-informed headache care.”
