literature review action verbs

Best Active Verbs for Research Papers with Examples

What are active verbs.

Active verbs, often referred to as "action verbs," depict activities, processes, or occurrences. They energize sentences by illustrating direct actions, like "run," "write," or "discover." In contrast, linking verbs connect the subject of a sentence to its complement, offering information about the subject rather than denoting an action. The most common linking verb is the "be" verb (am, is, are, was, were, etc.), which often describes a state of being. While active verbs demonstrate direct activity or motion, linking and "be" verbs serve as bridges, revealing relations or states rather than actions.

While linking verbs are necessary to states facts or show connections between two or more items, subjects, or ideas, active verbs usually have a more specific meaning that can explain these connections and actions with greater accuracy. And they captivate the reader’s attention! (See what I did there?)

Why are active verbs important to use in research papers?

Using active verbs in academic papers enhances clarity and precision, propelling the narrative forward and making your arguments more compelling. Active verbs provide clear agents of action, making your assertions clearer and more vigorous. This dynamism ensures readers grasp the research's core points and its implications.

For example, using an active vs passive voice sentence can create more immediate connection and clarity for the reader. Instead of writing "The experiment was conducted by the team," one could write, "The team conducted the experiment."

Similarly, rather than stating "Results were analyzed," a more direct approach would be "We analyzed the results." Such usage not only shortens sentences but also centers the focus, making the statements about the research more robust and persuasive.

Best Active Verbs for Academic & Research Papers

When writing research papers , choose active verbs that clarify and energize writing: the Introduction section "presents" a hypothesis, the Methods section "describes" your study procedures, the Results section "shows" the findings, and the Discussion section "argues" the wider implications. Active language makes each section more direct and engaging, effectively guiding readers through the study's journey—from initial inquiry to final conclusions—while highlighting the researcher's active role in the scholarly exploration.

Active verbs to introduce a research topic

Using active verbs in the Introduction section of a research paper sets a strong foundation for the study, indicating the actions taken by researchers and the direction of their inquiry.

Stresses a key stance or finding, especially when referring to published literature.

Indicates a thorough investigation into a research topic.

Draws attention to important aspects or details of the study topic you are addressing.

Questions or disputes established theories or beliefs, especially in previous published studies.

Highlights and describes a point of interest or importance.

Inspects or scrutinizes a subject closely.

Sets up the context or background for the study.

Articulates

Clearly expresses an idea or theory. Useful when setting up a research problem statement .

Makes something clear by explaining it in more detail.

Active verbs to describe your study approach

Each of these verbs indicates a specific, targeted action taken by researchers to advance understanding of their study's topic, laying out the groundwork in the Introduction for what the study aims to accomplish and how.

Suggests a theory, idea, or method for consideration.

Investigates

Implies a methodical examination of the subject.

Indicates a careful evaluation or estimation of a concept.

Suggests a definitive or conclusive finding or result.

Indicates the measurement or expression of an element in numerical terms.

Active verbs to describe study methods

The following verbs express a specific action in the methodology of a research study, detailing how researchers execute their investigations and handle data to derive meaningful conclusions.

Implies carrying out a planned process or experiment. Often used to refer to methods in other studies the literature review section .

Suggests putting a plan or technique into action.

Indicates the use of tools, techniques, or information for a specific purpose.

Denotes the determination of the quantity, degree, or capacity of something.

Refers to the systematic gathering of data or samples.

Involves examining data or details methodically to uncover relationships, patterns, or insights.

Active verbs for a hypothesis or problem statement

Each of the following verbs initiates a hypothesis or statement of the problem , indicating different levels of certainty and foundations of reasoning, which the research then aims to explore, support, or refute.

Suggests a hypothesis or a theory based on limited evidence as a starting point for further investigation.

Proposes a statement or hypothesis that is assumed to be true, and from which a conclusion can be drawn.

Attempts to identify

Conveys an explicit effort to identify or isolate a specific element or relationship in the study.

Foretells a future event or outcome based on a theory or observation.

Theorizes or puts forward a consideration about a subject without firm evidence.

Proposes an idea or possibility based on indirect or incomplete evidence.

Active verbs used to interpret and explain study results

In the Discussion section , the findings of your study are interpreted and explained to the reader before moving on to study implications and limitations . These verbs communicate the outcomes of the research in a precise and assertive manner, conveying how the data aligns with the expectations and hypotheses laid out earlier in the paper.

Shows or unveils findings from the data.

Demonstrates

Clearly shows the result of an experiment or study, often implying evidence of a cause-and-effect relationship.

Illustrates

Shows or presentes a particular result or trend.

Provides evidence in favor of a theory or hypothesis.

Establishes the truth or validity of an anticipated outcome or theory.

Visually presents data, often implying the use of figures or tables.

Active verbs to discuss study implications

In the discussion of study implications, these verbs help to weave the results into a broader context, suggesting relevance, highlighting importance, and pointing out potential consequences within the respective field of research.

Proposes a possible interpretation or implication without making a definitive statement.

Points to broader consequences or significances hinted at by the results.

Indicates a logical consequence or a meaning that is not explicitly stated.

Strengthens the validity or importance of a concept or finding.

Emphasizes certain findings and their broader ramifications.

Underscores

Underlines or emphasizes the significance or seriousness of an implication.

Active verbs to discuss study limitations

Discussing study limitations with these verbs allows researchers to maintain transparency about their study's weaknesses, thus providing a clearer picture of the context and reliability of the research findings.

Acknowledges

Recognizes the existence of potential weaknesses or restrictions in the study.

Directly confronts a specific limitation and often discusses ways it has been mitigated.

Makes an observation of a limitation that could affect the interpretation of the results.

Reflects on or thinks about a limitation in the context of the study's impact or scope.

Points out and describes a specific limitation.

Makes known or reveals a limitation that could have an effect on the study's conclusions.

Active verbs for the Conclusion section

In the Conclusion section , these verbs are pivotal in crystallizing the core findings, implications, and the future trajectory of research initiated by the study.

Signifies drawing a final inference or judgement based on the results.

Provides a brief statement of the main points of the research findings.

States positively or asserts the validity of the findings.

Advises on a course of action based on the results obtained.

Highlights the importance or significance of the research outcomes.

Use an AI Grammar Checker to Correct Your Research Verbs

While lists like these will certainly help you improve your writing in any academic paper, it can still be a good idea to revise your paper using an AI writing assistant during the drafting process, and with professional editing services before submitting your work to journals.

Wordvice’s AI Proofreading Tool , AI Paraphrasing Tool , AI Summarizer , AI Translator , AI Grammar Checker , AI Plagiarism Checker , and AI Detector are ideal for enhancing your academic papers. And with our professional editing services, including academic proofreading and paper editing services, you get high-quality English editing from experts in your paper’s subject area.

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Active verbs, active verbs for discussing ideas.

Use these lists for word variation when writing a research-based, analytical, or argumentative paper. However, be careful: there are no perfect synonyms. These words are not necessarily interchangeable.

Explanation and Examples

Why should I vary my verb choice?

Mark Twain once remarked , “The difference between the right word and the almost right word is the difference between lightning and a lightning bug.” Stronger diction (word choice) can result in a more interesting, vibrant, and sophisticated-sounding paper, but, more importantly, it will lead to clearer and more precise communication to your reader. Experiment with different words to discover and then state exactly what you mean!

What are the functions of these kinds of verbs?

The verbs on this handout offer a stronger link between your ideas and your source material. While the se kinds of verb s i ntroduce the supporting ideas and information, they also begin to indicate the relationship the quoted or paraphrased source material has with your larger point.

• B land and generic : Carol Dweck says , “ It is the belief that intelligence can be developed that opens students to a love of learning.”
• A more specific connection: Carol Dweck suggests , “ It is the belief that intelligence can be developed that opens students to a love of learning.”
• A stronger point argued : Carol Dweck emphasizes , “ It is the belief that intelligence can be developed that opens students to a love of learning.”
• The final, summative point: Carol Dweck concludes , “ It is the belief that intelligence can be developed that opens students to a love of learning.”

See the differences? Still, you should be careful to explain this significance or relevance more completely after using the source material.

You might imagine this like a “sandwich” within your paragraph. There might be several of these “ sandwiches ” within one body paragraph:

• Signal phrase or sentence with an active verb to introduce the source material (sometimes called a “lead-in”).
• Source material either paraphrased or directly quoted.
• Explanation of the significance / connection between that material and your larger point.

Here are some models that show effective ways of creating that “top bun ” of your “ sandwich. ” It would be followed by more evidence form you source, either paraphrased or quoted (middle layer), and then concluded with explanation of the source material’s significance (“bottom bun”):

• In his book The Status Syndrome , Jon Marmot hypothesizes that social class determines life outcomes (35).
• Paul Sawyer argues that geothermal energy is a wise alternative by highlighting several of its environmen tal and economic benefits (21-30).
• In the article “Impossibilities,” a professional educator ponders , “How does one teach when no one wants to learn?” ( Inayatullah 151).
• I n the article “Impossibilities,” a professional educator investigates a compell ing question: “How does one teach when no one wants to learn?” ( Inayatullah 151).
• Adaptations for format / ADA compliance. Authored by : Dann Coble. Provided by : Corning Community College. License : CC0: No Rights Reserved
• Authored by : Keith Ward. Provided by : Corning Community College. License : Public Domain: No Known Copyright

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15 Literature Review Examples

Chris Drew (PhD)

Dr. Chris Drew is the founder of the Helpful Professor. He holds a PhD in education and has published over 20 articles in scholarly journals. He is the former editor of the Journal of Learning Development in Higher Education. [Image Descriptor: Photo of Chris]

Learn about our Editorial Process

Literature reviews are a necessary step in a research process and often required when writing your research proposal . They involve gathering, analyzing, and evaluating existing knowledge about a topic in order to find gaps in the literature where future studies will be needed.

Ideally, once you have completed your literature review, you will be able to identify how your research project can build upon and extend existing knowledge in your area of study.

Generally, for my undergraduate research students, I recommend a narrative review, where themes can be generated in order for the students to develop sufficient understanding of the topic so they can build upon the themes using unique methods or novel research questions.

If you’re in the process of writing a literature review, I have developed a literature review template for you to use – it’s a huge time-saver and walks you through how to write a literature review step-by-step:

Get your time-saving templates here to write your own literature review.

Literature Review Examples

For the following types of literature review, I present an explanation and overview of the type, followed by links to some real-life literature reviews on the topics.

1. Narrative Review Examples

Also known as a traditional literature review, the narrative review provides a broad overview of the studies done on a particular topic.

It often includes both qualitative and quantitative studies and may cover a wide range of years.

The narrative review’s purpose is to identify commonalities, gaps, and contradictions in the literature .

I recommend to my students that they should gather their studies together, take notes on each study, then try to group them by themes that form the basis for the review (see my step-by-step instructions at the end of the article).

Example Study

Title: Communication in healthcare: a narrative review of the literature and practical recommendations

Citation: Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E., … & Vogelaers, D. (2015). Communication in healthcare: a narrative review of the literature and practical recommendations. International journal of clinical practice , 69 (11), 1257-1267.

Source: https://onlinelibrary.wiley.com/doi/pdf/10.1111/ijcp.12686  

Overview: This narrative review analyzed themes emerging from 69 articles about communication in healthcare contexts. Five key themes were found in the literature: poor communication can lead to various negative outcomes, discontinuity of care, compromise of patient safety, patient dissatisfaction, and inefficient use of resources. After presenting the key themes, the authors recommend that practitioners need to approach healthcare communication in a more structured way, such as by ensuring there is a clear understanding of who is in charge of ensuring effective communication in clinical settings.

Other Examples

• Burnout in United States Healthcare Professionals: A Narrative Review (Reith, 2018) – read here
• Examining the Presence, Consequences, and Reduction of Implicit Bias in Health Care: A Narrative Review (Zestcott, Blair & Stone, 2016) – read here
• A Narrative Review of School-Based Physical Activity for Enhancing Cognition and Learning (Mavilidi et al., 2018) – read here
• A narrative review on burnout experienced by medical students and residents (Dyrbye & Shanafelt, 2015) – read here

2. Systematic Review Examples

This type of literature review is more structured and rigorous than a narrative review. It involves a detailed and comprehensive plan and search strategy derived from a set of specified research questions.

The key way you’d know a systematic review compared to a narrative review is in the methodology: the systematic review will likely have a very clear criteria for how the studies were collected, and clear explanations of exclusion/inclusion criteria. 

The goal is to gather the maximum amount of valid literature on the topic, filter out invalid or low-quality reviews, and minimize bias. Ideally, this will provide more reliable findings, leading to higher-quality conclusions and recommendations for further research.

You may note from the examples below that the ‘method’ sections in systematic reviews tend to be much more explicit, often noting rigid inclusion/exclusion criteria and exact keywords used in searches.

Title: The importance of food naturalness for consumers: Results of a systematic review  

Citation: Roman, S., Sánchez-Siles, L. M., & Siegrist, M. (2017). The importance of food naturalness for consumers: Results of a systematic review. Trends in food science & technology , 67 , 44-57.

Source: https://www.sciencedirect.com/science/article/pii/S092422441730122X  

Overview: This systematic review included 72 studies of food naturalness to explore trends in the literature about its importance for consumers. Keywords used in the data search included: food, naturalness, natural content, and natural ingredients. Studies were included if they examined consumers’ preference for food naturalness and contained empirical data. The authors found that the literature lacks clarity about how naturalness is defined and measured, but also found that food consumption is significantly influenced by perceived naturalness of goods.

• A systematic review of research on online teaching and learning from 2009 to 2018 (Martin, Sun & Westine, 2020) – read here
• Where Is Current Research on Blockchain Technology? (Yli-Huumo et al., 2016) – read here
• Universities—industry collaboration: A systematic review (Ankrah & Al-Tabbaa, 2015) – read here
• Internet of Things Applications: A Systematic Review (Asghari, Rahmani & Javadi, 2019) – read here

3. Meta-analysis

This is a type of systematic review that uses statistical methods to combine and summarize the results of several studies.

Due to its robust methodology, a meta-analysis is often considered the ‘gold standard’ of secondary research , as it provides a more precise estimate of a treatment effect than any individual study contributing to the pooled analysis.

Furthermore, by aggregating data from a range of studies, a meta-analysis can identify patterns, disagreements, or other interesting relationships that may have been hidden in individual studies.

This helps to enhance the generalizability of findings, making the conclusions drawn from a meta-analysis particularly powerful and informative for policy and practice.

Title: Cholesterol and Alzheimer’s Disease Risk: A Meta-Meta-Analysis

Citation: Sáiz-Vazquez, O., Puente-Martínez, A., Ubillos-Landa, S., Pacheco-Bonrostro, J., & Santabárbara, J. (2020). Cholesterol and Alzheimer’s disease risk: a meta-meta-analysis. Brain sciences, 10(6), 386.

Source: https://doi.org/10.3390/brainsci10060386  

O verview: This study examines the relationship between cholesterol and Alzheimer’s disease (AD). Researchers conducted a systematic search of meta-analyses and reviewed several databases, collecting 100 primary studies and five meta-analyses to analyze the connection between cholesterol and Alzheimer’s disease. They find that the literature compellingly demonstrates that low-density lipoprotein cholesterol (LDL-C) levels significantly influence the development of Alzheimer’s disease.

• The power of feedback revisited: A meta-analysis of educational feedback research (Wisniewski, Zierer & Hattie, 2020) – read here
• How Much Does Education Improve Intelligence? A Meta-Analysis (Ritchie & Tucker-Drob, 2018) – read here
• A meta-analysis of factors related to recycling (Geiger et al., 2019) – read here
• Stress management interventions for police officers and recruits (Patterson, Chung & Swan, 2014) – read here

Other Types of Reviews

• Scoping Review: This type of review is used to map the key concepts underpinning a research area and the main sources and types of evidence available. It can be undertaken as stand-alone projects in their own right, or as a precursor to a systematic review.
• Rapid Review: This type of review accelerates the systematic review process in order to produce information in a timely manner. This is achieved by simplifying or omitting stages of the systematic review process.
• Integrative Review: This review method is more inclusive than others, allowing for the simultaneous inclusion of experimental and non-experimental research. The goal is to more comprehensively understand a particular phenomenon.
• Critical Review: This is similar to a narrative review but requires a robust understanding of both the subject and the existing literature. In a critical review, the reviewer not only summarizes the existing literature, but also evaluates its strengths and weaknesses. This is common in the social sciences and humanities .
• State-of-the-Art Review: This considers the current level of advancement in a field or topic and makes recommendations for future research directions. This type of review is common in technological and scientific fields but can be applied to any discipline.

How to Write a Narrative Review (Tips for Undergrad Students)

Most undergraduate students conducting a capstone research project will be writing narrative reviews. Below is a five-step process for conducting a simple review of the literature for your project.

• Search for Relevant Literature: Use scholarly databases related to your field of study, provided by your university library, along with appropriate search terms to identify key scholarly articles that have been published on your topic.
• Evaluate and Select Sources: Filter the source list by selecting studies that are directly relevant and of sufficient quality, considering factors like credibility , objectivity, accuracy, and validity.
• Analyze and Synthesize: Review each source and summarize the main arguments  in one paragraph (or more, for postgrad). Keep these summaries in a table.
• Identify Themes: With all studies summarized, group studies that share common themes, such as studies that have similar findings or methodologies.
• Write the Review: Write your review based upon the themes or subtopics you have identified. Give a thorough overview of each theme, integrating source data, and conclude with a summary of the current state of knowledge then suggestions for future research based upon your evaluation of what is lacking in the literature.

Literature reviews don’t have to be as scary as they seem. Yes, they are difficult and require a strong degree of comprehension of academic studies. But it can be feasibly done through following a structured approach to data collection and analysis. With my undergraduate research students (who tend to conduct small-scale qualitative studies ), I encourage them to conduct a narrative literature review whereby they can identify key themes in the literature. Within each theme, students can critique key studies and their strengths and limitations , in order to get a lay of the land and come to a point where they can identify ways to contribute new insights to the existing academic conversation on their topic.

Ankrah, S., & Omar, A. T. (2015). Universities–industry collaboration: A systematic review. Scandinavian Journal of Management, 31(3), 387-408.

Asghari, P., Rahmani, A. M., & Javadi, H. H. S. (2019). Internet of Things applications: A systematic review. Computer Networks , 148 , 241-261.

Dyrbye, L., & Shanafelt, T. (2016). A narrative review on burnout experienced by medical students and residents. Medical education , 50 (1), 132-149.

Geiger, J. L., Steg, L., Van Der Werff, E., & Ünal, A. B. (2019). A meta-analysis of factors related to recycling. Journal of environmental psychology , 64 , 78-97.

Martin, F., Sun, T., & Westine, C. D. (2020). A systematic review of research on online teaching and learning from 2009 to 2018. Computers & education , 159 , 104009.

Mavilidi, M. F., Ruiter, M., Schmidt, M., Okely, A. D., Loyens, S., Chandler, P., & Paas, F. (2018). A narrative review of school-based physical activity for enhancing cognition and learning: The importance of relevancy and integration. Frontiers in psychology , 2079.

Patterson, G. T., Chung, I. W., & Swan, P. W. (2014). Stress management interventions for police officers and recruits: A meta-analysis. Journal of experimental criminology , 10 , 487-513.

Reith, T. P. (2018). Burnout in United States healthcare professionals: a narrative review. Cureus , 10 (12).

Ritchie, S. J., & Tucker-Drob, E. M. (2018). How much does education improve intelligence? A meta-analysis. Psychological science , 29 (8), 1358-1369.

Roman, S., Sánchez-Siles, L. M., & Siegrist, M. (2017). The importance of food naturalness for consumers: Results of a systematic review. Trends in food science & technology , 67 , 44-57.

Sáiz-Vazquez, O., Puente-Martínez, A., Ubillos-Landa, S., Pacheco-Bonrostro, J., & Santabárbara, J. (2020). Cholesterol and Alzheimer’s disease risk: a meta-meta-analysis. Brain sciences, 10(6), 386.

Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E., … & Vogelaers, D. (2015). Communication in healthcare: a narrative review of the literature and practical recommendations. International journal of clinical practice , 69 (11), 1257-1267.

Wisniewski, B., Zierer, K., & Hattie, J. (2020). The power of feedback revisited: A meta-analysis of educational feedback research. Frontiers in Psychology , 10 , 3087.

Yli-Huumo, J., Ko, D., Choi, S., Park, S., & Smolander, K. (2016). Where is current research on blockchain technology?—a systematic review. PloS one , 11 (10), e0163477.

Zestcott, C. A., Blair, I. V., & Stone, J. (2016). Examining the presence, consequences, and reduction of implicit bias in health care: a narrative review. Group Processes & Intergroup Relations , 19 (4), 528-542

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Writing an effective literature review

Lorelei lingard.

Schulich School of Medicine & Dentistry, Health Sciences Addition, Western University, London, Ontario Canada

In the Writer’s Craft section we offer simple tips to improve your writing in one of three areas: Energy, Clarity and Persuasiveness. Each entry focuses on a key writing feature or strategy, illustrates how it commonly goes wrong, teaches the grammatical underpinnings necessary to understand it and offers suggestions to wield it effectively. We encourage readers to share comments on or suggestions for this section on Twitter, using the hashtag: #how’syourwriting?

This Writer’s Craft instalment is the second in a two-part series that offers strategies for effectively presenting the literature review section of a research manuscript. This piece argues that citation is not just a technical practice but also a rhetorical one, and offers writers an expanded vocabulary for using citation to maximal effect.

Many writers think of citation as the formal system we use to avoid plagiarism and acknowledge others’ work. But citation is a much more nuanced practice than this. Not only does citation allow us to represent the source of knowledge, but it also allows us to position ourselves in relation to that knowledge, and to place that knowledge in relation to other knowledge . In short, citation is how we artfully tell the story of what the field knows, how it came to that knowledge, and where we stand in relation to it as we write the literature review section to frame our own work. Seen this way, citation is a sophisticated task, requiring in-depth knowledge of the literature in a domain.

Citation is more than just referencing; it is how we represent the social construction of knowledge in a field. A citation strategy is any indication in the text about the source and nature of knowledge. Consider the following passage, in which all citation strategies are italicized:

Despite years of effort to teach and enforce positive professional norms and standards, many reports of challenges to medical professionalism continue to appear, both in the medical and education literature and, often in reaction, in the lay press . 1,2,3,4,5 Examples of professional lapses dot the health care landscape: regulations are thwarted, records are falsified, patients are ignored, colleagues are berated. 2,4,6 The medical profession has articulated its sense of what professionalism is in a number of important position statements . 7,8 These statements tend to be built upon abstracted principles and values, such as the taxonomy presented in the American Board of Internal Medicine’s (ABIM’s) Project Professionalism : altruism, accountability, excellence, duty, honour, integrity, and respect for others. 7 (From Ginsburg et al., The anatomy of a professional lapse [ 1 ])

In this passage, citation as referencing (in the form of Vancouver format superscript numbers) is used to acknowledge the source of knowledge. There are more than just references in this passage, however. Citation strategies also include statements that characterize the density of that knowledge (‘many reports’), its temporal patterns (‘continue to appear’), its diverse origins (‘both in the medical and education literature’), its social nature (‘often in reaction’), and its social import (‘important position statements’). Citation does more than just acknowledge the source of something you’ve read. It is how you represent the social nature of knowledge as coming from somewhere, being debated and developed, and having impact on the world [ 2 ]. If we remove all these citation strategies, the passage sounds at best like common sense or, at worst, like unsubstantiated personal opinion:

Despite years of effort to teach and enforce positive professional norms and standards, challenges to medical professionalism continue. Examples of professional lapses dot the health care landscape: regulations are thwarted, records are falsified, patients are ignored, colleagues are berated. Professionalism is a set of principles and values: altruism, accountability, excellence, duty, honour, integrity, and respect for others.

But perhaps you’ve been told that your literature review should be ‘objective’—that you should simply present what is known without taking a stance on it. This is largely untrue, for two reasons. The first involves the distinction between summary and critical summary. A summary is a neutral description of material, but a good literature review contains very little pure summary because, as we review, we must also judge the quality, source and reliability of the knowledge claims we are presenting [ 3 ]. To do this, we engage in critical summary, not only summarizing existing knowledge but offering a stance on it.

The second reason is that, even when we’re aiming for simple summary, a completely neutral presentation of knowledge claims is very difficult to achieve. We take a stance in ways we hardly even notice. Consider how the verb in each of these statements adds a flavour of stance to what is otherwise a summary of a knowledge claim in the field:

Anderson describes how the assessment is overly time-consuming for use in the Emergency Department. Anderson discovered that the assessment was overly time-consuming for use in the Emergency Department. Anderson claims that the assessment is overly time-consuming for use in the Emergency Department.

The first verb, ‘describes’, is neutral: it is not possible to ascertain the writer’s stance on the knowledge Anderson has contributed to the field. The second verb, ‘discovered’, expresses an affiliation or positive stance in the writer, while the third verb, ‘claims’, distances the writer from Anderson’s work. Even these brief summary sentences contain a flavour of critical summary. This is not a flaw; in fact, it is an important method of portraying existing knowledge as a conversation in which the writer is positioning herself and her work. But it should be done consciously and strategically. Tab.  1 offers examples to help writers think about how the verbs in their literature review position them in relation to existing knowledge in the field. Meaning is subject to context and these examples should only be taken as a guide: e. g., ‘suggests’ can be used to signal neutrality or distancing.

Verbs to position the writer in relation to the literature being reviewed

Most of us have favourite verbs that we default to almost unconsciously when we are writing—reports, argues, describes, studies, explains, asserts—but these verbs are not interchangeable. They each inscribe a slightly different stance towards the knowledge—not only the writer’s stance, but also the stance of the researcher who created the knowledge. It is critical to get the original stance right in your critical summary. Nothing irritates me more than seeing my stance mispresented in someone else’s literature review. For example, if I wrote a paragraph offering tentative reflections on a new idea, I don’t want to see that summarized in someone’s literature review as ‘Lingard argues’, when more accurate would be ‘Lingard suggests’ or ‘Lingard explored’.

Writers need to extend their library of citation verbs to allow themselves to accurately and persuasively position knowledge claims published by authors in their field. You can find many online resources to help extend your vocabulary: Tab.  2 , adapted from one such online source [ 4 ], provides some suggestions. Tables like these should be thought of as tools, not rules—keep in mind that words have flexible meanings depending on context and purpose. This is why one word, such as suggest or conclude , can appear in more than one list.

Verbs to represent the nature and strength of an author’s contributions to the literature

Knowledge is a social construction and it accumulates as researchers debate, extend and refine one another’s contributions. To avoid your literature review reading like a laundry list of disconnected ‘facts’, reporting verbs are an important resource. Tab.  3 offers a selection of verbs organized to reflect different relationships among authors in the field of knowledge being reviewed.

Verbs to express relations among authors in the field

Finally, although we have focused on citation verbs in this article, adverbs (e. g., similarly, consequently) and prepositional phrases (e. g., by contrast, in addition) are also important for expressing similar, contrasting or responding relations among knowledge claims and their authors in the field being reviewed.

In summary, an effective literature review not only summarizes existing knowledge, it also critically presents that knowledge to depict an evolving conversation and understanding in a particular domain of study. As writers we need to know when we are summarizing and when we are critically summarizing—summary alone makes for a literature review that reads like a laundry list of undigested ‘facts-in-the-world’. Finally, writers need to attend to the subtle power of citation verbs to position themselves and the authors they are citing in relation to the knowledge being reviewed. Broadening our catalogue of ‘go-to’ verbs is an important step in enlivening and strengthening our writing.

Acknowledgements

Thanks to Mark Goldszmidt for his feedback on an early version of this manuscript.

PhD, is director of the Centre for Education Research & Innovation at Schulich School of Medicine & Dentistry, and professor for the Department of Medicine at Western University in London, Ontario, Canada.

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Action Verbs | Definition, List & Examples

Published on September 18, 2023 by Kassiani Nikolopoulou .

An action verb (also called a dynamic verb ) describes the action that the subject of the sentence performs (e.g., “I  run”).

Action verbs differ from stative verbs, which describe a state of being (e.g., “believe,” “want”).

My grandfather walks with a stick.

The train arrived on time.

You can download our list of common action verbs in the format of your choice below.

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Table of contents

What is an action verb, how to use action verbs, action verbs vs. stative verbs, action verbs vs. linking verbs, worksheet: action verbs, other interesting language articles, frequently asked questions.

An action verb is a type of verb that describes the action that the subject of a sentence is performing. Action verbs can refer to both physical and mental  actions (i.e., internal processes and actions related to thinking, perceiving, or feeling).

Whitney analyzed  the data to find patterns.

He played  football in high school.

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Action verbs can be transitive or intransitive. Transitive verbs require a direct object , such as a noun or pronoun , that receives the action. Without a direct object, sentences with a transitive verb are vague or incomplete.

In contrast, intransitive verbs do not require a direct object that receives the action of the verb. However, other information may come after the verb, such as an adverb .

Some action verbs can act as both transitive and intransitive  verbs.

He grows  tomatoes on his balcony. My niece is growing quickly. Note Because action verbs make your writing more vivid, they can be effectively used for resume writing. Unlike generic phrases like “responsible for,” “tasked with,” or “experienced in,” action verbs are attention-grabbing and help emphasize our abilities and accomplishments.

• I was responsible for social media accounts across various platforms.
• I managed social media accounts across various platforms.

Action or dynamic verbs are often contrasted with stative verbs . While action verbs communicate action, stative verbs describe a state of being or perception (e.g., “it tasted,” “he is,” “she heard”). Due to this, they are typically used to provide more information about the subject, rather than express an action that the subject did. For example, the sentence “Tom loves spending time with friends” uses a stative verb “love” to give us more information about Tom’s personality.

However, some verbs can be used as either dynamic or stative verbs depending on the meaning of the sentence. For example, the verb “think” can denote someone’s opinion ( stative verb ) or the internal process of considering something ( action verb ).

One way to tell action verbs from stative verbs is to look at the verb tenses . Because stative verbs usually describe a state of being that is unchanging, they can’t be used in the continuous (or progressive) tenses. Action verbs, on the other hand, can be used in continuous tenses.

• I am wanting  some food.
• I want some food.

Another way is to look at the meaning of the sentence and ask yourself if the verb shows what someone does or how someone feels or is. If the verb describes what someone does, it is an action verb. Otherwise, it is probably a stative verb.

Action verbs should not be confused with linking verbs , like “be,” “become,” and “seem.” Linking verbs connect the subject of a sentence with a subject complement (i.e., a noun or adjective that describes it).

Unlike action verbs, linking verbs do not describe an action, but add more details about the subject, such as how it looks or tastes.

For example, the sentence “The children seem happy” uses the linking verb “seem” to link the subject (“the children”) with the adjective (“happy”).

Some verbs can be either linking verbs or action verbs . If you are unsure, try replacing the linking verb with a conjugated form of the verb “be.” If the sentence still makes sense, then it is a linking verb.

To test your understanding of action verbs, try the worksheet below. Choose the correct answer for each question.

• Practice questions
• Answers and explanations
• Are you baking cookies? They_______[smell/are smelling] delicious!
• Understand is not an action verb, but a stative verb because we can’t use it in a continuous tense. For example, “I’m not understanding you at all” is incorrect.
• Kick is an action verb, while “believe” and “agree” are both stative verbs.
• Smell is correct because it is a stative verb and cannot be used in the present continuous.

If you want to know more about commonly confused words, definitions, common mistakes, and differences between US and UK spellings, make sure to check out some of our other language articles with explanations, examples, and quizzes.

Nouns & pronouns

• Common nouns
• Proper nouns
• Collective nouns
• Personal pronouns
• Uncountable and countable nouns
• Verb tenses
• Phrasal verbs
• Sentence structure
• Active vs passive voice
• Subject-verb agreement
• Interjections
• Determiners
• Prepositions

There are many ways to categorize verbs into various types. A verb can fall into one or more of these categories depending on how it is used.

Some of the main types of verbs are:

• Regular verbs
• Irregular verbs
• Transitive verbs
• Intransitive verbs
• Dynamic verbs
• Stative verbs
• Linking verbs
• Auxiliary verbs
• Modal verbs

If you are unsure whether a word is an action verb , consider whether it is describing an action (e.g., “run”) or a state of being (e.g., “understand”). If the word describes an action, then it’s an action verb.

The function of an action verb is to describe what the subject of the sentence is doing. For example, in the sentence “You have been working since 7 o’clock this morning,” the action verb “work” shows us what the subject (“you”) has been doing.

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100+ Research Vocabulary Words & Phrases

The academic community can be conservative when it comes to enforcing academic writing style , but your writing shouldn’t be so boring that people lose interest midway through the first paragraph! Given that competition is at an all-time high for academics looking to publish their papers, we know you must be anxious about what you can do to improve your publishing odds.

To be sure, your research must be sound, your paper must be structured logically, and the different manuscript sections must contain the appropriate information. But your research must also be clearly explained. Clarity obviously depends on the correct use of English, and there are many common mistakes that you should watch out for, for example when it comes to articles , prepositions , word choice , and even punctuation . But even if you are on top of your grammar and sentence structure, you can still make your writing more compelling (or more boring) by using powerful verbs and phrases (vs the same weaker ones over and over). So, how do you go about achieving the latter?

Below are a few ways to breathe life into your writing.

1. Analyze Vocabulary Using Word Clouds

Have you heard of “Wordles”? A Wordle is a visual representation of words, with the size of each word being proportional to the number of times it appears in the text it is based on. The original company website seems to have gone out of business, but there are a number of free word cloud generation sites that allow you to copy and paste your draft manuscript into a text box to quickly discover how repetitive your writing is and which verbs you might want to replace to improve your manuscript.

Seeing a visual word cloud of your work might also help you assess the key themes and points readers will glean from your paper. If the Wordle result displays words you hadn’t intended to emphasize, then that’s a sign you should revise your paper to make sure readers will focus on the right information.

As an example, below is a Wordle of our article entitled, “ How to Choose the Best title for Your Journal Manuscript .” You can see how frequently certain terms appear in that post, based on the font size of the text. The keywords, “titles,” “journal,” “research,” and “papers,” were all the intended focus of our blog post.

2. Study Language Patterns of Similarly Published Works

Study the language pattern found in the most downloaded and cited articles published by your target journal. Understanding the journal’s editorial preferences will help you write in a style that appeals to the publication’s readership.

Another way to analyze the language of a target journal’s papers is to use Wordle (see above). If you copy and paste the text of an article related to your research topic into the applet, you can discover the common phrases and terms the paper’s authors used.

For example, if you were writing a paper on  links between smoking and cancer , you might look for a recent review on the topic, preferably published by your target journal. Copy and paste the text into Wordle and examine the key phrases to see if you’ve included similar wording in your own draft. The Wordle result might look like the following, based on the example linked above.

If you are not sure yet where to publish and just want some generally good examples of descriptive verbs, analytical verbs, and reporting verbs that are commonly used in academic writing, then have a look at this list of useful phrases for research papers .

3. Use More Active and Precise Verbs

Have you heard of synonyms? Of course you have. But have you looked beyond single-word replacements and rephrased entire clauses with stronger, more vivid ones? You’ll find this task is easier to do if you use the active voice more often than the passive voice . Even if you keep your original sentence structure, you can eliminate weak verbs like “be” from your draft and choose more vivid and precise action verbs. As always, however, be careful about using only a thesaurus to identify synonyms. Make sure the substitutes fit the context in which you need a more interesting or “perfect” word. Online dictionaries such as the Merriam-Webster and the Cambridge Dictionary are good sources to check entire phrases in context in case you are unsure whether a synonym is a good match for a word you want to replace. 

To help you build a strong arsenal of commonly used phrases in academic papers, we’ve compiled a list of synonyms you might want to consider when drafting or editing your research paper . While we do not suggest that the phrases in the “Original Word/Phrase” column should be completely avoided, we do recommend interspersing these with the more dynamic terms found under “Recommended Substitutes.”

A. Describing the scope of a current project or prior research

B. Outlining a topic’s background

C. Describing the analytical elements of a paper

D. Discussing results

E. Discussing methods

F. Explaining the impact of new research

Wordvice Writing Resources

For additional information on how to tighten your sentences (e.g., eliminate wordiness and use active voice to greater effect), you can try Wordvice’s FREE APA Citation Generator and learn more about how to proofread and edit your paper to ensure your work is free of errors.

Before submitting your manuscript to academic journals, be sure to use our free AI Proofreader to catch errors in grammar, spelling, and mechanics. And use our English editing services from Wordvice, including academic editing services , cover letter editing , manuscript editing , and research paper editing services to make sure your work is up to a high academic level.

We also have a collection of other useful articles for you, for example on how to strengthen your writing style , how to avoid fillers to write more powerful sentences , and how to eliminate prepositions and avoid nominalizations . Additionally, get advice on all the other important aspects of writing a research paper on our academic resources pages .

17 strong academic phrases to write your literature review (+ real examples)

A well-written academic literature review not only builds upon existing knowledge and publications but also involves critical reflection, comparison, contrast, and identifying research gaps. The following 17 strong academic key phrases can assist you in writing a critical and reflective literature review.

Academic key phrases to present existing knowledge in a literature review

The topic has received significant interest within the wider literature..

Example: “ The topic of big data and its integration with AI has received significant interest within the wider literature .” ( Dwivedi et al. 2021, p. 4 )

The topic gained considerable attention in the academic literature in…

Studies have identified….

Example: “ Studies have identified the complexities of implementing AI based systems within government and the public sector .” ( Dwivedi et al. 2021, p. 6 )

Researchers have discussed…

Recent work demonstrated that….

Example: “Recent work demonstrated that dune grasses with similar morphological traits can build contrasting landscapes due to differences in their spatial shoot organization.” ( Van de Ven, 2022 et al., p. 1339 )

Existing research frequently attributes…

Prior research has hypothesized that…, prior studies have found that….

Example:  “ Prior studies have found that court-referred individuals are more likely to complete relationship violence intervention programs (RVIP) than self-referred individuals. ” ( Evans et al. 2022, p. 1 )

Academic key phrases to contrast and compare findings in a literature review

While some scholars…, others…, the findings of scholar a showcase that… . scholar b , on the other hand, found….

Example: “ The findings of Arinto (2016) call for administrators concerning the design of faculty development programs, provision of faculty support, and strategic planning for online distance learning implementation across the institution. Francisco and Nuqui (2020) on the other hand found that the new normal leadership is an adaptive one while staying strong on their commitment. ” ( Asio and Bayucca, 2021, p. 20 )

Interestingly, all the arguments refer to…

This argument is similar to….

If you are looking to elevate your writing and editing skills, I highly recommend enrolling in the course “ Good with Words: Writing and Editing Specialization “, which is a 4 course series offered by the University of Michigan. This comprehensive program is conveniently available as an online course on Coursera, allowing you to learn at your own pace. Plus, upon successful completion, you’ll have the opportunity to earn a valuable certificate to showcase your newfound expertise!

Academic key phrases to highlight research gaps in a literature review

Yet, it remains unknown how…, there is, however, still little research on…, existing studies have failed to address….

Example: “ University–industry relations (UIR) are usually analysed by the knowledge transfer channels, but existing studies have failed to address what knowledge content is being transferred – impacting the technology output aimed by the partnership.”  (Dalmarco et al. 2019, p. 1314 )

Several scholars have recommended to move away…

New approaches are needed to address…, master academia, get new content delivered directly to your inbox, 26 powerful academic phrases to write your introduction (+ real examples), 13 awesome academic phrases to write your methodology (+ real examples), related articles, 10 tips on how to use reference management software smartly and efficiently, separating your self-worth from your phd work, how to introduce yourself in a conference presentation (in six simple steps), how to write effective cover letters for a paper submission.

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Active verbs for discussing ideas.

This handout is available for download in PDF format .

Active verbs are important components of any academic writing! Just as in other forms of writing, they work as engines, driving the action of your sentences in many potentially vivid, clear, and colorful ways.

Instead of opting for bland, unspecific expressions ("says," "writes about," "believes," "states") consider using more vivid or nuanced verbs such as "argues," "insists," "explains," "emphasizes," "challenges," "agrees," etc. The list below offers dozens of such verbs that will help you communicate your ideas and the ideas of others more clearly, expressively, and powerfully.

• "mentions," unless you mean "refer to something briefly and without going into detail."*
• "notion" as a synonym for "idea" implies "impulsive," "whimsical," not well considered.*

Adapted from a list by Cinthia Gannett by Doug Kirshen and Robert B. Cochran, Brandeis University Writing Program, 2020.

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The Significance of Research Verbs: Elevating Academic Writing

Want to master the art of writing? Start with research verbs! Learn how to make your writing more informative & interesting with our guide.

Despite their unassuming looks, research verbs carry substantial weight in academic writing. The building blocks of argument development, method explanation, and evidence presentation are research verbs. Researchers can communicate their findings clearly and demonstrate the rigor and trustworthiness of their research by choosing the appropriate research verbs. Furthermore, by clarifying the author’s thought process and assisting in comprehension, these verbs can aid readers in navigating the complexity of academic literature. 

Although they are of remarkable significance, research verbs are frequently misused, despite the fact that they are extremely important in determining the impact and clarity of academic writing. This article by Mind the Graph explores the essential significance of using the right research verbs to improve the quality and effectiveness of academic discourse.

What are Research Verbs?

Research verbs are a specific and essential category of words utilized in academic writing to convey the actions, procedures, and findings of research. They play a significant role in enhancing the clarity, precision, and effectiveness of researchers’ writing, enabling them to express their intentions with greater impact.

Within academic writing, research verbs cover a broad spectrum of actions and concepts associated with research. They encompass verbs used to describe research methods (e.g., investigate, analyze, experiment), present research findings (e.g., demonstrate, reveal, illustrate), and discuss implications and conclusions (e.g., suggest, propose, validate).

The careful selection of research verbs holds utmost importance as it directly influences the overall tone, rigor, and credibility of academic writing. By choosing the most fitting research verbs, researchers can ensure their writing is precise, clear, and accurate, allowing them to effectively communicate their research to their intended audience.

In addition to research verbs, selecting the right words throughout the academic writing process is crucial. It contributes to the attainment of the aforementioned goals of precision, clarity, and accuracy. To gain deeper insights into the importance of word choice in academic writing, read the article titled “ The Importance of Word Choice with Examples. ” This article offers valuable perspectives and practical examples that can further enhance your understanding of the significance of word choice in academic writing.

Types of Research Verbs

There are various types of research verbs that are commonly used in academic writing. These verbs can be categorized based on their specific functions and the stages of the research process they represent. 

Verbs for Analyzing Data

To examine, understand, and gain significant insights from research findings, particular verbs are used when analyzing data. These verbs aid in the exploration of connections, the discovery of patterns, and the drawing of conclusions based on the available facts:

• Analyze: Systematically examine data to find patterns or connections.
• Interpret: Describe the relevance of the data or outcomes and their meaning.
• Compare: Show how several data sets or variables differ from one another.
• Correlate: Examine the connection or relationship between variables.
• Calculate: Perform calculations on data using math or statistics.

Verbs for Defining Processes 

Defining research processes entails providing specifics on the steps, procedures, and methods used throughout the study. Verbs in this category facilitate a clear and accurate explanation of how the research was conducted:

• Outline: Provide a general overview or structure of a research process.
• Detail: Elaborate on the specific steps or procedures undertaken in the research.
• Explain: Clarify the rationale or logic behind a particular research process.
• Define: Clearly state and describe key concepts, variables, or terms.
• Illustrate: Use examples or visuals to demonstrate a research process.

Verbs for Summarizing Results 

After the research has been concluded, researchers provide a succinct summary of their results. These verbs help researchers highlight key findings, give an overview of the findings, and draw conclusions from the data:

• Summarize: Provide a concise overview or brief account of research findings.
• Highlight: Draw attention to the key or significant results.
• Demonstrate: Present evidence or data that supports a particular finding.
• Conclude: Formulate a generalization or inference based on the results.
• Validate: Confirm or corroborate the findings through additional evidence or analysis.

Verbs for Describing Literature Review

During the literature review phase, researchers examine existing scholarly works and relevant studies. Verbs in this category help researchers express their evaluation, synthesis, and analysis of the literature. Such verbs include, for instance:

• Critique: Evaluate the strengths and weaknesses of existing literature on a topic.
• Summarize: Provide a brief overview of the key findings and conclusions of existing literature on a topic.
• Compare: Identify similarities and differences between the findings and conclusions of multiple studies on a topic.
• Synthesize: Combine the findings and conclusions of multiple studies on a topic to identify broader trends or themes.
• Evaluate: Assess the quality and validity of existing literature on a topic.

Verbs for Speculating and Hypothesizing

Exploring possible connections or explaining occurrences requires speculation and the formulation of hypotheses. These verbs allow researchers to present their speculations, assumptions, or proposed hypothesis:

• Propose: Put forward an idea or hypothesis for further study or investigation.
• Speculate: Offer a possible explanation or theory for a phenomenon or observation.
• Predict: Use existing data or theories to make a forecast about future events or outcomes.
• Hypothesize: Formulate a testable explanation or hypothesis for a phenomenon or observation.
• Suggest: Offer a potential explanation or interpretation for a result or finding.

Verbs for Discussing Limitations and Future Directions

Acknowledging the limitations of the research and suggesting future directions is important for demonstrating a comprehensive understanding of the field. Verbs in this category help researchers address the constraints of their study and provide insights for future research:

• Limit: Identify the limitations or weaknesses of a study or analysis.
• Propose: Suggest potential solutions or avenues for further research to address limitations or weaknesses.
• Discuss: Analyze and reflect on the implications of limitations or weaknesses for the broader field or research area.
• Address: Develop a plan or strategy for addressing limitations or weaknesses in future research.
• Acknowledge: Recognize and address potential biases or limitations in a study or analysis.

Tips for Using Research Verbs

These tips will help you make the most of research verbs, ensuring that your language is active, precise, and consistent. By incorporating these strategies, you can elevate the quality of your writing and effectively communicate your research findings to your readers.

Using Active Language

• Use active voice: Active voice makes your writing more dynamic and engaging. It also clearly identifies the doer of the action. For example, instead of saying “The data were analyzed,” say “We analyzed the data.”
• Highlight the subject: Ensure that the subject of the sentence is the main focus and performs the action. This brings clarity and emphasizes responsibility.

Choosing Precise Verbs

• Be specific: Select verbs that precisely convey the action you want to describe. Avoid generic verbs like “do” or “make.” Instead, use verbs that accurately depict the research process or findings. For example, use “investigate,” “analyze,” or “demonstrate.”
• Utilize a thesaurus: Expand your vocabulary and find alternative verbs that convey the exact meaning you intend. A thesaurus can help you discover more precise and varied verbs.

Maintaining Consistency

• Stay consistent in verb tense: Choose a verb tense and maintain it consistently throughout your writing. This ensures coherence and clarity.
• Establish a style guide: Follow a specific style guide, such as APA or MLA, to maintain consistency in the use of research verbs and other writing conventions.

Resources to Help You Use Research Verbs

Take into consideration the following resources to improve your use of research verbs:

• Writing Manuals and Guides: For reliable information on research verbs and academic writing, consult guides such as  “The Craft of Research” or “The Elements of Style.”
• Academic Writing Workshops: Attend webinars or workshops on academic writing that address subjects like research verbs and enhancing scholarly writing.
• Online Writing Communities: Participate in online writing communities where researchers exchange materials and discuss writing techniques. 
• Language and Writing Apps: Use grammar checker tools like Grammarly or ProWritingAid for grammar and style suggestions.

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About Jessica Abbadia

Jessica Abbadia is a lawyer that has been working in Digital Marketing since 2020, improving organic performance for apps and websites in various regions through ASO and SEO. Currently developing scientific and intellectual knowledge for the community's benefit. Jessica is an animal rights activist who enjoys reading and drinking strong coffee.

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Explore different ways of referring to literature and foregrounding your voice.

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Reporting verbs help you introduce the ideas or words of others as paraphrase or quotation from scholarly literature. Always accompanied by a reference, they indicate where you’re drawing on other people’s work to build your own argument. They also indicate  your stance  (agree, disagree, etc) on the scholarship you’re describing, highlighting your critical contribution. There are lots of reporting verbs to choose from and, depending on the context, they might be used to convey more than one stance, so you’ll notice that some appear in more than one category. 

The following reporting verbs have been organised according to the critical stances they signal.

Neutral description of what the text says

Reporting verbs.

• Observes 
• Describes 
• Discusses 
• Reports 
• Outlines 
• Remarks 
• States 
• Goes on to say that 
• Quotes that 
• Mentions 
• Articulates 
• Writes  
• Relates  
• Conveys 

Abrams mentions that culture shock has “long been misunderstood as a primarily psychological phenomenon” (34)  

Chakrabarty outlines the four stages of mitosis (72-3)

Acceptance as uncontested fact, having critiqued it

• Recognises 
• Clarifies 
• Acknowledges 
• Concedes 
• Accepts 
• Refutes 
• Uncovers 
• Admits 
• Demonstrates 
• Highlights 
• Illuminates 
• Supports  
• Concludes 
• Elucidates 
• Reveals 
• Verifies  

Abrams refutes the idea that culture shock is a “primarily psychological phenomenon” (34)

Chakrabarty demonstrates that mitosis actually occurs over five stages (73)

Recognition that this is one perspective on or interpretation of an issue or conclusion, and others might be possible

• Argues 
• Reasons 
• Maintains 
• Contends 
• Hypothesises 
• Proposes 
• Theorises  
• Feels 
• Considers 
• Asserts 
• Disputes 
• Advocates 
• Opines  
• Thinks  
• Implies  
• Posits 

Abrams contends that culture shock is socially produced (38)

Chakrabarty hypothesises that metaphase is a more complex process than previously thought (77)

Agreement with that perspective, interpretation or conclusion

• Shows 
• Illustrates  
• Points out 
• Proves 
• Finds 
• Explains 
• Agrees 
• Confirms 
• Identifies 
• Evidences  
• Attests  

Abrams points out that culture shock is a “stress response mechanism” (34)

Chakrabarty proves that mitosis is irreversible, once triggered (80)

Disagreement with that perspective, interpretation or conclusion

• Believes 
• Claims 
• Justifies 
• Insists  
• Assumes  
• Alleges 
• Denies 
• Speculates  
• Disregards 
• Supposes  
• Conjectures  
• Surmises 

Abrams’ analysis disregards the neurochemical factors that contribute to culture shock (36)

Chakrabarty speculates that “metaphase is the most important stage of mitosis” (78)

Slight reservations held - probably true but being cautious

Reporting verb.

• Notes 
• Suggests 
• Challenges 
• Critiques  
• Emphasises 
• Declares 
• Indicates 
• Comments 
• Upholds  

Abrams asserts that theories of culture shock have moved away from psychological explanations.

Chakrabarty emphasises the role of metaphase within mitosis (78)

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Use the following verb tenses to report information in APA Style papers.

Verb tense is covered in the seventh edition APA Style manuals in the Publication Manual Section 4.12 and the Concise Guide Section 2.12

From the APA Style blog

Check your tone: Keeping it professional

When writing an APA Style paper, present ideas in a clear and straightforward manner. In this kind of scholarly writing, keep a professional tone.

The “no second-person” myth

Many writers believe the “no second-person” myth, which is that there is an APA Style guideline against using second-person pronouns such as “you” or “your.” On the contrary, you can use second-person pronouns in APA Style writing.

The “no first-person” myth

Whether expressing your own views or actions or the views or actions of yourself and fellow authors, use the pronouns “I” and “we.”

Navigating the not-so-hidden treasures of the APA Style website

This post links directly to APA Style topics of interest that users may not even know exist on the website.

Welcome, singular “they”

This blog post provides insight into how this change came about and provides a forum for questions and feedback.

190+ Action Verbs: Powerful Words and Examples

Check out our guide with action verbs to add to your next piece of writing; create impactful storylines that keep your readers hooked with these powerful verbs.

Action verbs add an extra “oomph!” to your writing, helping you to describe the many things your characters will achieve throughout the story. Learning how to use action verbs will enhance your writing, help to define your characters, and allow your readers to grasp the plot points with ease.

However, action verbs aren’t just for story writing. They’re also ideal to use in your resume when applying for jobs. Check out what Indeed.com says about using action verbs:

“The action verbs give the reader a clear understanding of what is happening. When used within a resume or cover letter, action verbs help the application package stand out from other submissions.”

So, it’s important to learn the correct action verbs to use in your writing to make a lasting impact on the readers. Whether you’re working on a fiction book, an essay, or sprucing up your resume, we’ve got everything you need to level up your writing. If you’re interested in this topic, check out our list of feeling words for more!

What Are Action Verbs?

Mental action verbs, action verbs denoting personal improvement, action verbs denoting productivity  , action verbs denoting ability, action verbs denoting leadership traits, action verbs denoting initiative, action verbs denoting excellent communication skills, finance action verbs.

Action verbs, a.k.a. dynamic verbs, express an action a person takes. They are one of two major categories of verbs in English (the other one being stative verbs). In other words, active verbs describe what a person is doing or has done and are, consequently, often used in business.

One typical example where action verbs shine is the bullet statement format used when the writer wants to describe their accomplishments using a bare minimum of words. However, remember that not all action verbs are made equal. The words that cement the image of the writer accomplishing something instead of merely being in charge of it are the best choice.

E.g., “handling” is not as illustrative as “executing.” Precision takes precedence and makes a lasting impact. Therefore, pick your verbs carefully. You might also be interested in our list of boring words and phrases to avoid in your writing.

Action Verbs Printable

Mental action verbs describe intellectual or inner dynamic actions. Discerning them can be challenging as many stative verbs describe thoughts and opinions. Therefore, we’re starting with some notable examples of mental action verbs. You might also be interested in our homophones word list .

He was analyzing testimonials all night and was late for work in the morning.

2. Appreciate

He appreciates that cooperation with the sales department is a necessary evil.

3. Consider

Mark considered his roommate’s decisions as foolish but kept silent.

As a child, Anna dreamt of playing the flute, but her parents never allowed it.

5. Evaluate

Nicholas wasn’t able to evaluate the situation properly due to shock.

I fear that the situation is getting out of hand.

Don’t forget to bring the book tomorrow!

The idea is growing on me.

I imagine you’re referring to Star Wars.

The CEO failed to learn anything from employee feedback.

11. Memorize

I try to memorize five new Chinese words every day.

I’m always pondering how to improve my attitude in adversity.  

13. Remember

She could vaguely remember Nick’s face after all those years they’d been apart.

14. Resolve

He resolved to learn Japanese and head the regional branch.

Reviewing for exams can help students join the dots seamlessly.

Don’t you think John was unhappy about the prospect?

To underline success, professional and personal alike, you may use suitable action verbs denoting improvement. Here are some examples: 

17. Accomplish

I think I’ve accomplished much in this short amount of time.

18. Customize

Our IT team has customized the chatbot.

19. Demonstrate

They demonstrated their knowledge during the seminar.

Merging the two start-ups was the best decision they ever made.  

Larry modified his views to meet project requirements.

22. Overhaul

Shareholders have decided to overhaul the training program.

She set to revamp company policies to include hybrid work models.

24. Revitalize

Yoga classes can help you revitalize your body and spirit in no time.

25. Streamline

Mark worked hard to streamline operations to benefit the entire team.

26. Strengthen

She strengthened her resolve to deal with her past trauma.

27. Surpass     

He has truly surpassed himself with his latest whitepaper.

I’m just testing my theory out; is there something wrong with that?

Did you know she trained as a psychologist before becoming a translator?

30. Transform

Transforming my career advancement plans is the best thing I’ve ever done.

31. Translate

My teacher says I must translate this sentence twenty times to grasp synonyms.

We’d appreciate it if you could keep us updated on the procedure.

33. Upgrade

I’ve upgraded my skills! Now, I’m a high-level wizard!

There are many action verbs suitable for business English. Let’s consider some examples of verbs denoting productivity. You might also be interested in our list of describing words .

34. Achieve

I need to work hard to achieve my goals.

Becoming an author can be one of the most creative and rewarding careers.

36. Publish

The feeling of publishing your first novel is like nothing else; the excitement and pride you will feel are unparalleled.

37. Actualize

To actualize your potential, you need to train harder.

He’s adapting the play to suit a wider audience.

39. Address

He addressed the audience with an enthusiasm rarely witnessed before.

Individuals need to adjust their approach to suit the team.

41. Advance

The creditor advanced $100 million to help the business with debt repayments.

42. Amplify

Maria’s vision of the upcoming meeting with shareholders was amplifying her morale.

The initiative aims to boost sales during the peak season.

44. Capitalize

He capitalized on the sudden increase in demand.

45. Collect

I’m going to collect the latest issue of the magazine first thing tomorrow morning.

46. Compute

The management uses feedback to compute the rate of employee performance.

47. Conceive

I simply can’t conceive how you could be so insensitive!

48. Conceptualize

I’m unsure if I’ll be able to conceptualize the bigger picture, but I’ll give it my best shot.

49. Consolidate

The HR department consolidated its processes in an attempt to attract talent.

50. Construct

I’m constructing the argument in my mind and have yet to shape it into words.

51. Co-produce

Good news, everyone: we’ll be co-producing the new car model with Honda!

Hannah curated the exhibit alongside her husband, rumored to be an expert in the field. 

Nina has been tasked with debugging the company’s in-house software.

54. Deliver

Ronaldo rarely fails to deliver a perfect pass.

We’ve hired a wildly popular digital artist to design our holiday brochure.

He’s good at devising out-of-the-box solutions; that’s why we hired him in the first place.

57. Diagnose

Will you be able to diagnose the error by the end of the day?

58. Enhance

Simon is trying to enhance his reputation by demonstrating his unique expertise.

59. Expedite

Teams’ efforts expedited departmental plans.

60. Explore

The brand is exploring collaborating on a new project with the new regional start-up .

61. Further

Mary’s donation furthered her company’s positive outlook.

62. Improve

We need to improve our merger plans.

63. Maximize

Johanna’s superb design skills maximized company impact during the presentation.  

64. Proofread

Nicholas proofreads books for an established publishing company.

65. Reconcile

Reconciling opposing viewpoints may be challenging, but we need to succeed all the same.

66. Stimulate

Her speech stimulated everyone present to perform better.

67. Sustain

Seasonal earnings will sustain our business during the dormant season.

She refused to yield power to the shareholders.

Action verbs can be used to efficiently communicate one’s ability. Here are some examples to help you get started.

69. Administer

They had to administer the revenues to prevent unfair play.

I’m thinking of learning to code programs.

71. Complete

He is working overtime to complete work.

72. Develop

She’s trying to develop empathy in an attempt to reinvent herself.

73. Document

We need to document and report employee feedback before the next meeting.

74. Drive                        

Sadly, Mary can’t drive, although she’s having none of it!

She edits a business magazine that’s becoming more popular by the day.

76. Execute

The higher-ups are set to execute the new strategy.

There’s much I need to learn to expand my views.

78. Implement

We plan to implement a policy allowing all new hires to sign up for benefits.

79. Interpret

We need to interpret the stats as best we can; we’re not getting any help from higher-ups.

80. Operate

Do you know how to operate the machines?

81. Organize

If I wanted you to organize my life, I wouldn’t have looked for a roommate.

82. Perform

I need to study more if I want to perform better than average.

83. Prepare

I am prepared for any eventuality.  

84. Realize

Can you realize the target or not?

Action verbs can be rather impactful when denoting leadership traits. They communicate expertise and willingness to deal with any obstacle. Here are the finest examples of dynamic verbs denoting leadership aspirations and expertise:

85. Arrange

I’ll arrange everything, so the only thing you need to do is follow through.

Management assessed the cost of the latest marketing initiative at ca. £7,000.

I’m assigning this job to you because I find your soft skills quite suitable.

My brother said he’d assist me with the task.

You need to decide on your own how to attain the goal; it’s rather subjective.

90. Authorize

To appeal to the workforce, the CEO authorized additional PTO.  

He’s built his career around his seamless communication skills.

Peculiarly enough, chairing the meeting is a new hire.

She is performing her tasks so seamlessly that I’m wondering if she’s been coached by a professional.

94. Coordinate

We need to coordinate our efforts to get the job done ASAP.

95. Delegate

Shouldn’t she be delegating work faster?

Higher-ups are deploying resources more sparingly due to past grievances.

A police officer is directing the traffic again.

98. Empower

The matter of how to empower remote workers is gaining broad recognition.

Is it right to enable new hires to become workaholics?

100. Encourage

Top brass are encouraging project development as it is expected to make them rich overnight.

101. Enforce

The police are trying to enforce speed limits with varying degrees of success.

102. Engineer

Can we engineer a successful meeting between office employees and remote teams?

103. Examine

They’re examining the cause of the failure with the help of our brand-new AI solution.

104. Exceed

He is exceeding all expectations; he’s truly a marvel!

105. Explain

Joshua explained to his mates that he’d be leaving the band due to personal obligations.

106. Foster

They’re fostering a sense of inclusivity, but I can tell they’re not too happy about the whole affair.

107. Fulfill

He has failed to fulfill his promise and is trying to make amends.

Mr. Smith guided us through all the trials and tribulations of the takeover.

He is heading the meeting regardless of the uproar.

Helping him overcome the divorce was the best thing I ever did.

111. Individualize

Our HR teams are individualizing onboarding programs to allow for better personalization.

112. Inspect

We went to inspect the damage after the flood.

113. Instruct

The management instructed the team to align goals with the brand mission.

114. Invest

He’s invested in his studies and hardly has any spare time for anything else.

115. Investigate

They’ve investigated allegations of corruption and found nothing conclusive.

116. Lecture

Is he lecturing newcomers again?

Businesses are lobbying for proposed changes in the tax laws.

118. Maintain

Jonny is maintaining a healthy lifestyle with a little help from his wife.

119. Manage

He has managed finances for as long as I can remember.

120. Map         

IT teams are mapping all network drives at the moment.

121. Moderate

Mary thinks she needs to moderate her stance as she came across as overly harsh.

Our HR experts mold new hires’ characters with ease.

123. Motivate

I am motivated to help my friends achieve their goals.

124. Network

Company meetings are a good opportunity to network .

125. Orchestrate

He charged us with orchestrating the production.

126. Outperform

Our company will easily outperform our biggest competitor again.

127. Oversee

We need to appoint an engineer to oversee the construction.

128. Participate

We’ll all participate in the upcoming get-along and are fired up.

129. Partner

Mark and Maria partnered for the competition, hoping to place better.

They are planning a project in line with new directives.

131. Preside

The new integrator will preside at tomorrow’s meeting.

Their HR representative probed into my private life, and I’m outraged!

133. Project

The revenue is projected to surge again.

134. Spearhead

He spearheaded the company’s expansion into the U.S.A.

135. Supervise

The logistics department is supervising the distribution of resources.

136. Support

I planned to support her claim, but she’d been lying through her teeth.

By nature, initiative portends action. That’s why dynamic verbs are so illustrative in this regard. Take a look at a couple of examples below:

I’m asking you again: “Will you be joining us tonight?”

138. Balance

Balancing professional and private life can get tricky during the peak season.

139. Budget

An additional $10 million needs to be budgeted for new projects in Q3.

140. Calculate

I’m calculating the total right now.

Mr. Watson is continually charting the progress of each team member, so be careful.

We’ll be able to close the deal tomorrow.

143. Co-author

Maria and her brother have co-authored a vegetarian cookbook.

144. Collaborate

We’ll be collaborating with a Korean firm to develop the new product.

145. Create

Creating new initiatives is going as planned, so don’t worry.

146. Discover

I’m discovering more about the wabi-sabi concept with each passing day.

147. Establish                    

Establishing a new regional branch sounds like a good idea at this point.

148. Facilitate

To facilitate group discussion, project leaders should be inventive.

To form an impactful sentence, you should consider using active verbs.

Who founded the museum, do you know?

151. Formalize

They are planning to formalize the deal, but details have yet to be defined.

152. Formulate

Try as I might, I failed to formulate a proper response.

153. Gather

Everyone should gather here after work as we will throw a welcome party.

154. Initiate

There are several ways to initiate knowledge sharing, and AI is just the tip of the iceberg.

155. Institute

Policymakers are about to institute a number of measures to enforce public safety.

156. Introduce

Today, he’ll be introducing new technological developments in healthcare.

Join us for the outing tonight; it’ll be fun.

Don’t joke around; it’s a serious matter!

The football player kicked his opponent during the match and was removed from the game.

160. Launch

We’re launching the project tomorrow, so prepare for potential inquiries.   

161. Pioneer

He’s regarded as a pioneer in the world of art and literature.

Your son is playing with matchsticks again!

163. Present

I’ll present the latest developments I’ve worked hard to come by.

164. Propose

The judge proposed the establishment of special tribunals for the trial of offenses disturbing the general peace.

He did raise some important questions, but the audience remained silent.

I’ll have reached NY headquarters by 5 PM.

167. Survey

I’m surveying the terrain now, so give me some time, and I’ll get back to you with the findings.

168. Team (up)

They teamed up for the upcoming competition, and their morale is through the roof!

I’ve been tutoring my son, but he’s still as dumb as a brick! It’s infuriating!

170. Visualize

I can visualize my future in the company going forward.

Communication rules supreme, especially in the age of rapid digitalization. Use action verbs to demonstrate your skill! Let’s illustrate best practices.

171. Convince

I am sure I can convince her to share her thoughts.

172. Communicate

We need to communicate the news during the meeting.

173. Compose

It took me some time to compose myself after the incident.

174. Cooperate

My son refuses to cooperate and denies his involvement in the incident.

175. Correspond

He still corresponds with Jamaican friends he met in Germany five years ago.

176. Define

Will you be able to define what’s wrong with this initiative?

Yes, he is drafting the legislation, but he’s taking his time.

178. Illustrate

Let me give you an example to illustrate the point.

179. Outline

The professor outlined his methodology in his latest book.

180. Persuade

Can I persuade you to come with us to the meet-up after work?

181. Promote

Mark was promoted to the First Division after nailing down his previous mission.

182. Publicize

He never did publicize his book, but it was an instant success nevertheless.

We’ve managed to find a volunteer to write our manifest.

Finally, finance experts use action verbs galore and not without a good reason. This hectic industry is best described by dynamic words, but do note that these verbs can be equally impactful in other contexts as well.

Let’s take a look at some notable examples.

184. Appraise

The team is appraising the property , with estimates still being vague.

They audit all accounts annually to ensure they align with company policies.

186. Convert

He keeps converting all his cash from pounds into dollars. Is he planning to visit the States?

187. Decrease

I’m decreasing the revenue forecast due to last month’s unexpected losses.

188. Estimate

Analysts estimate the trend will be reversing any time now.

189. Forecast

Shareholders forecast the profit to grow by 2% in this quarter.

I’ve lowered the assessment to reflect recent data.

191. Measure

Measuring the impact of public involvement in research is never an easy task.

192. Qualify

They seem to think that reading a couple of books on AI qualifies them as experts.

193. Reduce

Team members worked hard to reduce the negative impact the latest marketing initiative had invoked.

194. Report

Reporting with the latest developments is our journalist Mark. Mark, tell us what’s going on!

195. Research

Researching her prior experiences, Viola discovered how to further her goals.

Financial aid is available to help those struggling with essential payments like rent or mortgage fees.

197. Advise

A great accountant will advise you on the best business practices as well as help with your taxes.

Looking for more? Check out our list of adjectives for strong men !

Verbs Used in the Literature Review

To be more precise the list below contains “Verbs Used In The Literature Review To Present previous And/Or Current Research And Contributions. This includes all past tense verbs describing what researchers did, i.e. calculated, monitored, etc. Instead of just using did, showed and found, you often need to be more specific about what a researcher actually ‘did’!

  Here are some examples of how these are used:

• This phenomenon was demonstrated by…
• In their study, expanded T-cells were found in…
• Initial attempts focused on identifying the cause of…
• Weather severity has been shown to…
• Early data was interpreted in the study by…
• The algorithm has been proposed for these applications…
• The results on pair dispersion were reported in…
• Their study suggested a possible cause for…
•  An alternative approach was developed by …

 Reference:

Glasman, H. (2010). Science research writing for non-native speakers of English (pp. 36-37). Imperial College Press, London.

Hilary teaches PhD research writing courses and delivers workshops for native and non-native post-doctoral researchers, Visit my page

A guide to using EndNote X7

Practical Tips for Doctoral Students : Introduction

Identify a Target Journal for Your Publication 3/5

The Literature Review

Thesis / Journal Proofreading Checklist

Lindsay’s Laws of Thesis Writing

Thank you very much for this very important clarification. It is indeed very helpful.

seems no use of pronouns or at very rare rule , the possessive pronouns are used: a very strong adjectival phrasing in passive voice..colon phrase statement of a certain question followed by start up answering phrase, well followed by details coming up endlessly…… let me say: adjectival phrase short cut question, answered by adjectival phrase let us say politeness in language avoiding silly long talk before a question mark (?) with avoidance of affirmatively harsh answer ,” like i did it “… this as far someone could grasp understand phrasing..

Remarkable comment …

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• Open access
• Published: 11 September 2024

Mechanisms of manipulation: a systematic review of the literature on immediate anatomical structural or positional changes in response to manually delivered high-velocity, low-amplitude spinal manipulation

• Kenneth J. Young   ORCID: orcid.org/0000-0001-8837-7977 1 , 20 ,
• Charlotte Leboeuf-Yde 2 , 3 ,
• Lindsay Gorrell 4 ,
• Cecilia Bergström 5 ,
• David W. Evans 6 ,
• Iben Axén 7 , 8 ,
• Kenneth Chance-Larsen 9 ,
• Olivier Gagey 10 ,
• Vasileios Georgopoulos 11 ,
• Guillaume Goncalves 1 ,
• Catherine Harris 12 , 13 ,
• Steen Harsted 14 , 15 ,
• Roger Kerry 16 ,
• Edward Lee 17 ,
• Christopher McCarthy 18 ,
• Casper Nim 2 , 14 , 15 ,
• Luana Nyirö 4 ,
• Petra Schweinhardt 4 &
• Steven Vogel 19  

Chiropractic & Manual Therapies volume  32 , Article number:  28 ( 2024 ) Cite this article

842 Accesses

13 Altmetric

Metrics details

Spinal manipulation (SM) has been claimed to change anatomy, either in structure or position, and that these changes may be the cause of clinical improvements. The aim of this systematic review was to evaluate and synthesise the peer-reviewed literature on the current evidence of anatomical changes in response to SM.

The review was registered with PROSPERO (CRD42022304971) and reporting was guided by the standards of the PRISMA Statement. We searched Medline, Embase, CINAHL, AMED, Cochrane Library all databases, PEDro, and the Index to Chiropractic Literature from inception to 11 March 2022 and updated on 06 June 2023. Search terms included manipulation, adjustment, chiropractic, osteopathy, spine and spine-related structures. We included primary research studies that compared outcomes with and without SM regardless of study design. Manipulation was defined as high-velocity, low-amplitude thrust delivered by hand to the spine or directly related joints. Included studies objectively measured a potential change in an anatomical structure or in position. We developed a novel list of methodological quality items in addition to a short, customized list of risk of bias (RoB) items. We used quality and RoB items together to determine whether an article was credible or not credible. We sought differences in outcomes between SM and control groups for randomised controlled trials and crossover studies, and between pre- and post-SM outcomes for other study designs. We reported, in narrative form, whether there was a change or not.

The search retrieved 19,572 articles and 20 of those were included for review. Study topics included vertebral position (n = 3) facet joint space (n = 5), spinal stiffness (n = 3), resting muscle thickness (n = 6), intervertebral disc pressure (n = 1), myofascial hysteresis (n = 1), and further damage to already damaged arteries (n = 1). Eight articles were considered credible. The credible articles indicated that lumbar facet joint space increased and spinal stiffness decreased but that the resting muscle thickness did not change.

We found few studies on this topic. However, there are two promising areas for future study: facet joint space and spinal stiffness. A research strategy should be developed with funding for high quality research centres.

Spinal manipulation (SM) is an intervention that is commonly sought by people with back and neck pain. Manual therapists, chiropractors and osteopaths, in particular, commonly utilise SM as a therapeutic intervention [ 1 , 2 , 3 ]. SM is associated with improved clinical outcomes for certain musculoskeletal disorders [ 4 , 5 , 6 , 7 ]. As a result, SM is recommended in several treatment guidelines and reviews [ 8 , 9 , 10 , 11 ]. However, the underlying mechanism(s) of action need to be understood to determine appropriate indications for the application of SM as well as to maximize its therapeutic efficacy. That is, it is important to determine what is inside the “black box” of mechanism(s) of action of SM [ 12 ].

There are many theories and assertions on this topic [ 13 ], but there is no general consensus on the mechanism(s) of action of SM. It has been claimed that SM can change anatomy, such as repositioning vertebrae [ 14 ] or altering the thickness of muscles at rest [ 15 ]. It is proposed that these changes may be long-lasting [ 16 ]. Other claims include physiological changes, ranging from liberating Innate Intelligence [ 17 ], to modification of muscle strength [ 18 ] or reducing inflammation [ 19 ]. Historically, the nervous system has had a particular interest among chiropractors and osteopaths, as SM has been thought to affect spinal nerves [ 20 , 21 ], the autonomic nervous system [ 22 ], and even the brain [ 23 ].

These anatomical and/or physiological changes are then purported to explain any associated clinical improvements, such as increased function, reduced pain, relief from specific diseases, and better health in general [ 24 ]. If any of these proposed mechanisms can be supported by evidence, manual therapists will be able to offer to patients a coherent rationale for applying SM.

Any mechanism of manipulation is comprised of two aspects. First, the manipulation must have an effect in the body lasting beyond the application of SM, and this effect must lead to a change in clinical outcome. Both aspects must be investigated in turn to determine potential mechanisms of SM. Although it is possible that there is a cumulative effect from SM or that a minimum dosage is needed to create an effect, this has not been well documented. Therefore, to proceed in a stepwise fashion, it seems reasonable to first determine what the immediate effects may be of one single SM.

There is evidence on what happens within the spine, as a response to various forces applied during a high-velocity low-amplitude (HVLA) SM [ 25 , 26 , 27 , 28 ], such as the distribution of forces within tissues receiving the manipulation [ 29 ], and the amount and direction of displacement of vertebrae during SM [ 30 ], but a clear picture of what happens directly afterwards appears to be lacking.

Although there have been systematic reviews on some physiological effects of SM [ 31 , 32 , 33 ], to our knowledge, there are no systematic reviews that have attempted to synthesise evidence of the underlying anatomical mechanisms of SM. Therefore, we assessed the state of evidence of a measurable change anatomical structures that occurs following the application of SM.

The overall aim of this systematic review was to evaluate and synthesise the peer-reviewed literature on the immediate changes in or to anatomical structures in response to SM.

Our research objectives were as follows:

Identify, evaluate the quality of, and narratively synthesise the evidence that has been published in peer-reviewed research literature regarding immediate anatomical change after a spinal manipulation.

Identify gaps in understanding the anatomical effects of spinal manipulation and provide recommendations for future research.

Advisory board

A research project advisory board was convened for support and guidance, consisting of a chair (chiropractor KJY), an information specialist (CH), 2 chiropractors (CLY, IA), a physiotherapist (RK), an osteopath (SV), a medical doctor/chiropractor (PS), and an anatomist/orthopaedic surgeon (OG). Several had experience with systematic reviews.

Team and roles

In all, 14 people (6 chiropractors, 6 physiotherapists, and 2 osteopaths) were recruited to perform the screening of articles. Several team members practice clinically. One reviewer dropped out before screening was completed and was replaced by KJY. Another reviewer dropped out after the screening process and was replaced by LG. One researcher with a chiropractic background, experienced in systematic reviews (CLY), acted as referee and supervisor only. The screening of articles was divided between 7 teams of 2 people each.

Protocol registration and reporting

The review was registered with PROSPERO (CRD42022304971) and the reporting was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement [ 34 ].

Search strategy

We performed a broad search to capture as many relevant articles as possible and developed our search strategies with an experienced information specialist (CH). The search strategy included relevant subject headings and search terms relating to manipulation and the spine and was adapted for use in each database. We had no resources for a translation service, so we limited the search to the English language. We searched the following databases: Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), AMED (EBSCOhost), Cochrane Library all databases (via Wiley), PEDro ( https://pedro.org.au/ ), and the Index to Chiropractic Literature ( https://www.chiroindex.org/ ). All databases were searched from inception to 11 March 2022; the searches were updated on 06 June 2023. The full search strategy can be found in Additional File 1 .

In cases where full-text articles were not available through library services, we emailed the first author, if an email address was published in the article. If there was no email address listed, or if we received no response to an email query, we searched for the first author on ResearchGate and, if found, we sent a full-text article request. If there was no response or the author could not provide us with an article, it was excluded.

Terminology

We used the term “outcome variable” to represent what the researchers measured in each study, referring to the mechanism of manipulation being studied. For instance, if SM is hypothesised to improve a clinical outcome by restoring the position of a vertebra, the mechanism by which SM achieves this end outcome is by changing the position of a vertebra. The outcome variable measured in the experiment would, therefore, be the difference in vertebral position from pre- to post-manipulation. In relation to research findings, we used the term “positive” not as a value judgment, but rather as shorthand to denote when a post-SM change in measurement was reported, and the term “negative”, when no such change was reported.

Eligibility criteria

We included only peer-reviewed articles if they fulfilled certain criteria:

We included primary research studies that compared non-treated with treated anatomical structures, regardless of the study design. The articles had to define SM as an HVLA thrust delivered by hand to the spine or directly related joints (i.e., including the sacroiliac or costo-vertebral joints). The measurement of effect must have occurred after a single manipulation session, that is, not after a course of care. If articles did not state a specific time interval between SM and post-SM measurement, but their research designs, or the way the text was written gave the distinct impression that there was little delay between the manipulation and the post-SM measurement, they were included.

The SM could not have been combined with any other therapeutic interventions.

Studies must have objectively measured a potential change in anatomical structure (the physical attributes of one or more structures in the human body) or a change in position (the relationship of two or more structures to each other). Studies measuring range of motion were considered subjective and were not included, since participants or assessors could consciously or subconsciously influence the position during the measurement.

Anatomical change was considered to be distinct from change in physiological state. Therefore, we included articles that reported on resting muscle thickness, as opposed to contracted muscle thickness, because we considered muscle contraction to be a matter better considered under physiological effects of SM. It is possible that a change in resting muscle thickness may be due to a physiological process such as contraction/relaxation. However, there may also be a purely physical mechanism such as stretching. Therefore, we included it.

Animal studies were included, because objectively measured anatomical effects of SM are not subject to contextual effects as clinical outcomes may sometimes be.

If studies measured more than one outcome, only the relevant outcome(s) were considered for this review. For the full list of exclusion criteria, please see Additional File 2 .

Article selection

All articles retrieved through the literature searches were exported into EndNote X9.3.1 (Clarivate, Philadelphia, 2013). After duplicates were removed, the remaining articles were imported into the web-based Rayyan systematic review management application [ 35 ] for reference management and tracking of the screening process. The total number of articles was divided into 7 separate reviews on Rayyan, each given to a pair of reviewers to independently screen titles/abstracts. Full-text versions of the potentially included articles were obtained for screening by the same teams. Detailed written instructions were distributed to the reviewers prior to the screening processes and meetings were held with each pair prior to title/abstract screening to facilitate congruence in approach. In cases of disagreement between reviewers during phase one (title/abstract) or phase two (full text) screening, a third independent reviewer (KJY or LG) was consulted to achieve consensus. Finally, KJY and CB conducted a backward search, manually searching the reference lists from all articles included at the full-text screening stage for any missing articles.

Data extraction

The articles were grouped by topic, and reviewers self-assigned, as much as possible, to 1 or 2 topics, with 2 reviewers independently reviewing each topic. The reviewers were LN, DE, KJY (2 topics), RK, CB, CM, SH, VG, LG, EL GG, KCL, and CN. Each topic pair was overseen by a third reviewer, either KJY, LG or DE, who had knowledge of the topic and was designated as “leader” of the group. Calibration sessions were held by KJY with each team prior to data extraction to help ensure congruency of approach. Study descriptions, methodological quality, and risk of bias (RoB) data were extracted. The 7 pairs of reviewers independently extracted data, with conflicts resolved by discussion between them or with the leader. Findings for each team were reviewed by the leaders of each team. KJY, CLY, and DE reviewed all findings.

Extracted data

Article descriptions.

Descriptive information about each article was entered into a table. This included first author/year of publication, mechanism of spinal manipulation investigated, study design, study setting, study cohort, sample sizes of intervention and control groups, control group description, spinal region studied, outcome variable used, instrument used for measurement, and the time interval between SM and measurement.

Quality assessment and risk of bias

Because the articles we included had used objective measurements of anatomical/positional outcome variables, there were potential areas of technical error introduced during the experiments. For this reason, and informed by a previous publication [ 22 ], we considered the techniques used to study the various outcome variables, and developed a novel list of methodological quality items. These items related to technical aspects of the experiments and transparency in methods.

A standard RoB reporting tool was not applicable due to the heterogeneity of study designs. Further, RoB tools are suitable mainly for clinical studies, in which the influence of the study participant is important to account for. However, in the investigations included in our review, study participant influence would be absent, as they would not likely be able to influence technical readings relating to anatomical structures, either consciously or subconsciously. Therefore, study participants did not need to be blinded to treatment or control group allocation. They also did not need to be naïve to the treatment. Thus, we included RoB items only relating to the blinding of assessors and statisticians. We selected only RoB items that we considered appropriate for the relevant study designs, i.e., depending on if they had a control group or not. We also included random allocation when two interventions were compared because it was important that inherent differences between groups was eliminated. We then considered those quality and RoB items together to determine, whether an article was credible or not credible, in a process described below.

Results of each study were extracted, after the quality and RoB items were determined, to avoid reviewer bias of the quality/RoB assessment. The results of each of the studies were extracted from the articles by 3 members of the team. CM reviewed half the articles and SV reviewed the other half, each working in conjunction with KJY, who reviewed all articles. Conflicts and queries were resolved by discussion or consultation with CLY. Results were entered into separate tables for each outcome variable, including the ultimate finding on whether the anatomical structure was affected by the manipulation or not. All tables were consolidated and edited for readability, and each team reviewed and approved their consolidated tables.

Data synthesis

Assessment and weighting of quality and risk of bias.

Through consensus discussion, we defined the quality and RoB items by the consequences we assumed that they would have on the credibility of the data. For this purpose, we developed a dichotomous system of weighting. Items were determined to be either “critical” or “important”. “Critical” items were essential to the credibility of the results, whereas “important” items were those that were considered good practice but were not essential, in and of themselves, to a judgement on whether results could be considered credible.

Quality items

We considered 3 quality items to be “critical”. First was “evaluation tool(s) appropriate to measure outcome variable(s)”. The second critical item was “reported the reliability of outcome variable(s)”. The final critical quality item was “measurement tool calibrated” (if appropriate). The remaining quality items on our checklist were assessed as important, but not critical.

Risk of bias items

For non-RCT studies, we included only one RoB item, “assessor blinding to pre-post manipulation status”, and we considered it to be critical. For RCTs and crossover study designs, 2 RoB items were considered critical. First was “random allocation of participants”. The second was “assessor blinding to intervention group”. The remaining RoB item was “statistician blind to intervention/control group”, which is not commonly reported in articles. For this reason, we decided to classify it as important rather than critical.

Assessment of the certainty of evidence

We used the quality and RoB tables to establish “credibility” for each article and outcome variable. If a quality or RoB item was appropriately reported, it was left as white in the table. However, items that had not been reported or were poorly reported, were marked as yellow for important items and red for critical items.

We then made an overall assessment of credibility for each article, based on both the quality and RoB, after which each article was defined as “credible” or “not credible”. Articles were defined as credible if they had 0 red and 0–2 yellow items. Articles were defined as not credible if they had 1 or more red items or 3 or more yellow. Please see Table  1 for the key to interpreting the quality and RoB items as well as explanations of each.

Reporting of results

It was not suitable to pool the results for meta-analysis due to heterogeneity in outcome variables, study design, and participant characteristics. It was also not relevant, because our research question did not require a measurement (e.g., amount of facet joint space increase or cross-sectional area increase in muscle size) but rather just the presence or absence of change post-SM. These results were reported both in detail and summarized in tables as “positive” (i.e., there was a change post-SM) or “negative” (i.e., there was no change).

To excerpt maximum information from this research area, we reported results from all studies, but separately for the “credible” and “not credible” articles. We also included a summary of methodological issues in the Discussion to aid future researchers to improve this research area. Our rules on reporting data were as follows:

We reported differences between SM and control groups for RCTs and crossover studies and between pre- and post-SM groups for other study designs. When there were several results reported in one article, we used the “best” estimates (i.e., best case scenario of a “positive” outcome or difference pre-post SM). For example, one article reported a positive result when the participant was re-measured while remaining in side-posture position, but there was a “negative” result when the participant was returned to neutral (supine) position for post-SM measurement. In this case, we reported the positive result.

If there were no statistically significant differences or statistical significance tests were not reported, we provided, again, the “best” estimate (i.e., selecting the best-case scenario).

If no estimates (direct measurements) were reported, but rather only significance values, then we reported those.

Writing and editing the manuscript

To keep the workload achievable and to improve attention to detail in manuscript development, we used an iterative process. Each section of the paper (introduction, methods, results, and discussion) and all tables and figures were disseminated to the research team for comments at different stages. In cases of disagreement, an appropriate member or members of the advisory board were contacted, and discussions were held amongst team members until consensus was reached.

Of the original 19,572 articles (37,902 including duplicates), 20 articles that reported on 20 studies were ultimately included in this review (Fig.  1 ).

PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources. * Records were excluded by humans; no automation tools were used. ** Eleven articles were not available for full-text retrieval after having unsuccessfully attempted to contact the first author of each in two ways, as detailed in the Methods section. *** Three articles were retrieved which had their titles/abstracts in English but the manuscripts in a foreign language and thus were excluded at the full-text screening stage

Study descriptions

As shown in Table  2 , the reviewed articles included the following outcome variables: vertebral position (n = 3) [ 14 , 36 , 37 ], facet joint space (n = 5) [ 38 , 39 , 40 , 41 , 42 ], spinal stiffness (n = 3) [ 43 , 44 , 45 ], resting muscle thickness (n = 6) [ 15 , 46 , 47 , 48 , 49 , 50 ], intervertebral disc pressure (n = 1) [ 51 ], myofascial hysteresis (n = 1) [ 52 ], and further damage to damaged arteries (n = 1) [ 53 ].

Study designs included both controlled (n = 10) and uncontrolled (n = 10) studies. The number of study participants ranged from 1 to 250. The most commonly studied participants were healthy adults (n = 9). Two studies included animals.

Most studies (n = 12) took place in the United States of America, with a private chiropractic or osteopathic school as the most common setting (n = 6), while 3 studies explicitly stated that they used a lab setting. SM was most commonly performed on the lumbar spine or lumbopelvic area (n = 12).

Methodological quality

As can be seen in Tables 3 , 4 , 5 , 6 , and 7 , issues relating to the methodological quality varied. Regarding the two critical quality items, the first, “using an appropriate evaluation tool” was consistently lacking in the 3 articles on vertebral position, and the second, “reporting of the reliability of an outcome variable” was not present in 6 of the 11 articles.

Risk of bias

We did not find that critical RoB was a problem in studies using an RCT or crossover design (Tables 3 , 4 , 5 , 6 , and 7 ), as 7 of 9 such articles had no critical deficiencies in this domain. However, in other study designs, 7 of 11 articles did not report that outcome measurements had been taken by assessors who were blinded to the previous assessment.

Credibility

The RoB/quality tables (Tables 3 , 4 , 5 , 6 and 7 ) show that 8 of the 20 studies were considered credible, whereas the other 12 were considered not credible. Notably, two of the studies, reported by Konitzer [ 46 ] and Fritz [ 43 ], met all our quality and RoB criteria.

The numbers of articles reporting on credible studies were as follows: facet joint space (n = 4/5), spinal stiffness (n = 1/3), and resting muscle thickness (n = 3/6). Therefore, 1 of the 5 studies on facet joint space was not credible; 2 of the 3 studies on spinal stiffness were not credible and 3 of the 6 studies on resting muscle thickness were not credible. In addition, all the articles reporting on studies on vertebral position (n = 3), intervertebral disc (IVD) pressure (n = 1), further damage to damaged arteries (n = 1), and myofascial hysteresis (n = 1) were found to be not credible.

Results of credible studies by outcome variable

Results from the 8 credible studies are shown below, reported by outcome variable.

Facet joint space (n = 4/5)

Four of 5 studies on changes to facet joint space were considered credible. They all reported an increase in lumbar spine facet joint space post-side-posture manipulation for the “up” side facet joints, but only if the participant was re-scanned using magnetic resonance imaging (MRI) while maintaining side posture position. When returned to neutral position the increased joint space disappeared.

Spinal stiffness (n = 1/3)

Only 1 of the 3 studies on spinal stiffness was found credible and reported immediate reduced spinal stiffness post-SM.

Resting muscle thickness (n = 3/6)

Three of six studies on changes to resting muscle thickness were considered credible. These studies, using diagnostic ultrasound, reported no statistically significant differences in either the transverse or internal oblique abdominal muscles post-manipulation.

Results of not credible studies by outcome variable

Below are shown the results from the 12 not credible articles, reported by outcome variable.

Vertebral position (n = 3/3)

The results of these 3 not credible studies were conflicting; 2 articles reported post-SM changes in vertebral position, using plain radiography, whereas one reported no change post-SM using ultrasound.

Facet joint space (n = 1/5)

The 1 not credible study had only 2 participants measured for the relevant outcome variable as part of a larger study, in which all other participants also received traction before and after SM, and so were not considered controls. No change in facet joint space and no presence of pneumarthrosis (discrete bubble of intra-articular gas) was reported post-SM using computed tomography (CT).

Spinal stiffness (n = 2/3)

The 2 not credible studies found a reduction in spinal stiffness post-SM. One study used a mechanical indentometer; the other studied horses using a cable extensometer with a pressure sensor mat.

Results in the 3 not credible studies were conflicting. One reported a pre- post-SM difference in resting transverse abdominal muscle thickness. One reported a difference in the resting thickness of pelvic floor muscles in pregnant women but not in non-pregnant women. The third reported no difference in thickness for multifidus muscles. All studies made measurements using ultrasound.

Intervertebral disc pressure (n = 1/1)

There was 1 not credible study which found increased disc pressure post-SM for at least 15 s using a pressure probe inserted into the disc.

Myofascial hysteresis (n = 1/1)

The 1 not credible RCT used a durometer to measure hysteresis with mixed results that we found difficult to interpret.

Further damage to already damaged arteries (n = 1/1)

The 1 not credible study on this topic was an uncontrolled intervention. The article reported no further damage post-SM to vertebral arteries of dogs that were damaged prior to manipulation with an angioplasty cutting balloon. This study was stopped early for ethical reasons once no effect was detected.

Please see Table  8 for the results and credibility assessments of all studies.

Post-hoc analysis

Cross-referencing credibility with positive (change after SM) or negative (no change after SM) results of SM resulted in a mixed picture. Thus, there was no relationship between the credibility of studies with positive or negative results of these studies. For a visual summary of the findings by outcome variable, credibility, and whether an article reported positive or negative results, see Table  9 .

Summary of main findings

This systematic review included 8 articles that we considered to be credible and 12 that we regarded as not credible. They dealt with 7 proposed SM mechanisms of action: change in vertebral position, facet joint space, spinal stiffness, resting muscle thickness, IVD pressure, myofascial hysteresis, and further damage to damaged arteries. We include results from articles that we considered credible as well as ones we considered not credible, in order to report as fully and fairly as possible, any information published to this point on the immediate anatomical/positional changes in response to SM.

The credible articles reported that, post-SM, there were: (i) changes in facet joint space, (ii) changes in spinal stiffness, but (iii) no changes in resting muscle thickness after SM.

A comparison between the results of the credible and not credible articles revealed that the latter: (i) disagreed with the credible articles on facet joint space/pneumarthrosis (discrete bubble of intra-articular gas), (ii) agreed on spinal stiffness, but (iii) had conflicting results for resting muscle thickness.

In addition, the not credible articles reported (i) conflicting results between them on vertebral position, (ii) change in IVD pressure and (iii) change in myofascial hysteresis, but (iv) no further damage to already damaged arteries after SM.

Comparisons to the literature

To our knowledge, this is the first systematic review dealing exclusively with the immediate anatomical/positional changes in response to SM. However, a systematic review on spinal mobilisation (i.e., not HVLA manipulation) reported on articles that evaluated mainly clinical outcomes but also on some anatomical mechanisms [ 33 ]. Specifically, they included 4 articles that evaluated spinal stiffness, and 3 of the 4 reported reduced spinal stiffness after mobilisation (not HVLA SM). These findings thus aligned with the results in our 3 credible articles that reported reduced spinal stiffness post-SM.

Methodological considerations of the present systematic review

Literature search.

Important positive aspects of our literature search were that an experienced information specialist (CH) ensured that we consulted all relevant databases for this topic and that all databases were interrogated using the different input parameters necessary to retrieve the relevant articles. We also used broad search parameters with no date limit, to capture all relevant articles on the topic. The search was updated to ensure we captured any more recent articles prior to submission of our review. We limited the search to articles in English only. Although, therefore, we may have failed to include every relevant published article, we believe this to be a minor limitation, as most articles dealing with SM are typically published in the English language. Also, we did not follow the PRESS guideline recommendation [ 54 ] to perform a review of the search strategy, which might have affected the quality and comprehensiveness of our search.

Inclusion/exclusion criteria

To ensure that SM was the most likely reason for any potential change in an outcome variable, we included only articles on studies that performed pre- and post-SM measurements and reported this for a single SM session. If some effects of SM require multiple sessions to manifest, we would have missed out on such information. We also excluded articles that used SM in combination with any other therapeutic intervention. Therefore, if SM requires facilitation by another intervention for the effects to manifest, we would have missed those changes. There may have been differences among team members in interpretation of inclusion/exclusion criteria which could have led to articles being missed out, although we mitigated this possibility with calibration sessions and written instructions, so this is unlikely.

Full text screening

Eleven articles included at the title/abstract screening stage were not available for the full-text screening process. Nine of those were published in chiropractic subluxation-focused journals, thus not available through mainstream library systems, with authors either not found on ResearchGate or not responding to requests for articles. This missingness of data may have affected our conclusions, but our experience is that the “grey” chiropractic journals do not attract high quality articles, so we do not believe that our conclusions were impacted.

Quality/risk of bias

It is well known that clinical studies will more easily produce positive findings if the human factor is allowed to play an essential role by voluntarily or subconsciously introducing bias. This is the reason why systematic reviews assess the RoB before drawing conclusions on the validity of results. This phenomenon was clearly shown in a previous systematic review on the “effect” of spinal manipulative therapy (SMT) on non-musculoskeletal conditions [ 55 ]. All studies that were considered to have failed in preventing the “human factor” reported positive results, whereas none of the high-quality studies found there to be an “effect” of SMT [ 55 ].

We emphasized RoB only in relation to aspects that clearly could be influenced by the beliefs and wishes of the researchers. Experimental/basic science (e.g. laboratory) studies, are susceptible to fewer RoB items. Instead, commercial and university laboratories are often subjected to accreditation procedures [ 56 , 57 ], which are specific to the requirements of their area of activities and relate more to technicalities than to systematic human errors. Thus, the use of appropriate and calibrated tools that are operated by competent personnel would be paramount in preventing random errors in studies that rely on technical assessments, beyond that of human subjective observations and reactions.

Results in studies that deal with anatomical/positional changes after SM are, thus, unlikely to be influenced by the beliefs and wishes of study participants and clinicians, whereas the beliefs and wishes of the assessor and statistician could have an impact. Failing to use a reliable outcome variable, measuring changes with a non-calibrated machine, or allowing amateurs to conduct the study, could possibly induce bias but more likely result in random errors.

Therefore, in addition to the RoB, we accounted for several technical aspects, defined as “quality”. Quality issues are likely to cause non-systematic errors, as opposed to bias, which may cause systematic errors. Examples of quality issues that must be assured to prevent non-systematic errors are skills of assessment personnel and the calibration of measurement tools. To accurately judge the technical quality of studies, we ensured that each review team had at least one member with expertise in the area.

Nonetheless, the evaluation and weighting of methods was a subjective matter, and other investigators may have judged differently. There may also have been differences among team members in the interpretation of quality and RoB criteria, which could have led to differences in results. However, we mitigated that possibility with multiple calibration sessions and repeated consultations on iterations of the tables among the team members.

Results of studies

The results were extracted from each article only after the quality and RoB items were determined, to avoid reviewer bias of the quality/RoB assessment. To prevent biased results interpretation, extraction of the study outcomes and interpretation of findings were performed by other teams than the experts in the area, although the experts were invited to critically review the extracted findings and interpretations.

Part of the standard synthesis in systematic reviews is to identify ‘gaps in the literature’. However, these ‘gaps’ may not be areas that have not been studied, just areas that have not been studied well. By listing all the studies that have been conducted in this area and detailing all the methodological errors that we identified, we show which areas can be studied (or which may be too difficult to study with current technology) and also indicate how they may be studied better in the future.

Methodological considerations for reviewed articles and potential future studies

General comments.

In the hope of being helpful to future researchers, we provide some methodological comments regarding the techniques used to study the potential anatomical/positional effects of SM.

Only 8 of the 20 studies were assessed as credible. Consequently, this indicates that technical experimental studies have not been prioritised in environments that were created for such purposes, i.e., taking advantage of relevant equipment and skilled researchers working in dedicated research laboratories. Assessors for these procedures should be highly experienced or adequately trained. In addition, when there is a human element, it is important to establish inter-/intra-rater reliability of the assessors, before undertaking the study. Further, researchers must strive towards the use of measurement tools that are validated, and it is important to remember that some need to be calibrated. The use of frameworks like COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) [ 58 ] may be helpful in this process. Also, when measuring positions or spaces, it would be of utmost importance to place study subjects in identical positions before and after the SM, to prevent ‘normal’ aberrations and measurement errors due to distortion.

Items relating to relevant RoB should be observed, in particular, blinding of before-after readings in studies without control groups. Statisticians should be blinded to control/intervention readings. Statistical methods, cut points, etc. should be determined a priori, rather than after any results have been returned.

Comments relating to each outcome variable

Vertebral position.

Two of 3 studies on vertebral position used radiographs to try to capture very small post-SM changes (< 2 degrees of rotation [ 14 ] or < 4mm of displacement). However, we note that the use of plain radiography to detect very small changes in vertebral position is debatable, at best, and in our opinion, the use of radiography for these measurements was not appropriate [ 59 ]. Instead, we suggest that future investigations could use computed tomography, which offers much greater resolution. The precision and likely error tolerance of the measurement instrument should be stated in future studies.

The third study used ultrasound to measure paraspinal tissue thickness as a proxy for vertebral rotation. However, the pressure on the ultrasound head was not measured. This is important, as increased pressure could compress tissues and distort readings. Nevertheless, this method could hold promise for developing a method of measuring vertebral rotation without the use of ionising radiation (Tables 2 and 3 ).

Facet joint space

All 4 credible articles found an increase in facet joint space post-SM. However, as they were conducted by the same team of researchers, these results should be confirmed by at least 1 independent team.

MRI is likely optimal for viewing facet joint space increase that is retained after the SM event, as bone and capsule detail can be captured.

Theories exist on the potential role of SM on intra-articular meniscoids/discoids, synovial folds, and adhesions within the facet joints [ 60 , 61 , 62 , 63 , 64 , 65 ]. We found no relevant articles that investigated any of these anatomical variations/pathologies. We suggest that if someone wanted to study them, they may be visualised using high resolution imaging such as MRI (Tables 2 and 4 ).

Spinal stiffness

The use of the mechanical indentometer in 2 of the 3 studies on spinal stiffness was useful because it removed the human element from the interpretation of the measurements. Calibration of the tool is important in this area (Tables 2 and 5 ).

Resting muscle thickness

Since 3 credible studies all showed absence of changes to resting muscle thickness, we believe that this area no longer warrants further study. We found the study design in one of the not credible articles [ 50 ] overly complex and difficult to understand; it seemed to report on 2 crossover studies, with important differences between the intervention and control groups (Tables 2 and 6 ).

Intervertebral disc pressure

The 1 study conducted on IVD pressure showed that it is difficult to study. The use of a pressure-measuring probe to physically penetrate the disc is not attractive to study participants and seems ethically challenging, as it damages the disc tissue to an unknown extent. Perhaps an indirect method of measuring IVD pressure could be developed in the future, for instance using fluid diffusion into or out of the disc, as measured by MRI, as an indicator of pressure. Alternatively, perhaps candidates for IVD replacement could be included as participants (Tables 2 and 7 ).

Further damage to already damaged arteries

In vivo studies of arterial walls are also difficult to perform. In addition, it seems unlikely that SM can cause arterial damage de novo [ 66 , 67 , 68 , 69 , 70 , 71 , 72 ]. The assumption tested in this article is interesting, if one thinks that it is mainly arteries with pre-existing damage or pathology that are susceptible to further damage by SM. Hence, the authors devised a method to “pre-damage” vertebral arteries in dogs, as a proxy for “naturally occurring” damage or pathology. The types of lesions created were not predictable, for which reason the usefulness of this method is unclear.

The assessment method in this study was complex, using a fluoroscopically guided ultrasound probe as the measurement tool. However, magnetic resonance angiography would offer better resolution, or a micro-video-camera could allow direct visualisation of arterial damage.

Since vertebral artery dissection is so rare and only temporally linked to SM [ 73 , 74 ], the justification of sacrificing animals to study this should be considered (Tables 2 and 7 ).

Myofascial hysteresis

There were several unclear elements in this article, making it difficult for us to interpret how well the outcome variables in the article related to the concept of hysteresis (Tables 2 and 7 ).

Conclusions

Clinical perspectives.

Although this review is primarily valuable to researchers, clinicians should also benefit from our findings. It is a common clinical observation that patients can experience sudden relief immediately after SM. In our experience, when this happens, they may ask: “What exactly happened when you cracked my back?” As this review describes, there is no easy answer because of the many theories and few facts. Nevertheless, we suggest the following, which clinicians can modify to suit their practice and patients. Regarding anatomical/positional changes, it would be possible to say: “There is no simple answer, because the spine is a difficult area to study. It seems likely that the manipulation/adjustment causes some physical changes, but it is not known exactly how. Presently, though, we are fairly confident that the facets, i.e., the small joints at the back of the spine, open up a little bit. There also seems to be a measurable change in the stiffness of the spine immediately after manipulation. We assume that these changes are part of what helps you feel better.”

Research perspectives

There has been little research on anatomical mechanisms of SM, and most of the articles we found were not credible according to our assessment methods. The few studies that have been published are on a wide variety of topics, performed by a small number of researchers, and were often small studies (only 7 studies recruited more than 50 participants) that were not followed-up by other similar studies. It seems that there has been no coherent research planning strategy undertaken by any of the manual therapy professions to investigate the anatomical/positional mechanisms of SM. Therefore, there is an opportunity to develop research centres with areas of expertise that can lead high-quality studies in these areas concentrating on anatomically feasible outcome variables.

Cut points for meaningful changes should be established and should incorporate information such as normal variations, repeatability, and inter-and intra-examiner reliability. The time between the application of SM and the measurement of the potential effect is also important to establish, to infer mechanism(s).

The results of our review indicate that the 2 most promising areas for further study are changes to facet joint space and spinal stiffness after SM.

However, after having established what actually happens anatomically in response to SM, it would be important to continue by investigating whether these mechanisms also have a lagged effect and/or result in physiological reactions. Then, this potential chain of events must be linked to the clinical picture, that is, reduction of pain or improvement in function.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Concept and research design: KJY, CLY, CH. Coordination and quality assurance of article screening, critical appraisal and data extraction: KJY, CLY, PS, IA, LG, DE, OG, SV. Article screening, data extraction, and critical appraisal: KJY, CN, CB, CM, DE, EL, GG, KCL, LG, LN, RK, SH, VG, SV. Writing and final editing of the manuscript: KJY, CLY. All co-authors edited and approved the final manuscript. Humans wrote this manuscript with no assistance from artificial intelligence except for Microsoft Word autocorrect for help with spelling and grammar.

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Young, K.J., Leboeuf-Yde, C., Gorrell, L. et al. Mechanisms of manipulation: a systematic review of the literature on immediate anatomical structural or positional changes in response to manually delivered high-velocity, low-amplitude spinal manipulation. Chiropr Man Therap 32 , 28 (2024). https://doi.org/10.1186/s12998-024-00549-w

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Received : 26 January 2024

Accepted : 27 August 2024

Published : 11 September 2024

DOI : https://doi.org/10.1186/s12998-024-00549-w

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