Spinal manipulation therapy (SMT) is what chiropractors are traditionally known for. SMT is a type of therapy that involves the use of hands-on techniques, "adjustments", which apply a controlled force to the spine in order to improve mobility, reduce pain and to encourage proper neural signaling from the joints and tissues of the spine. It is often used to treat musculoskeletal conditions, such as neck and back pain, and may also be used to treat headaches and other conditions.

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SMT is based on the theory that the spine is a key component of the body's nervous system, and it contains many receptors which, if not working properly, it can lead to "dysafferentation". This means that a rogue or skewed signal from components within the spine (nerve, disc, joint, muscle) can cause pain and lead to further degeneration or increased pain.