Everything You Need to Know About Spinal Manipulation (2024)

Spinal manipulation therapy involves using the hands or another device to apply force to manipulate the joints in the spine. This form of therapy aims to improve mobility to relieve ailments such as lower back pain. Chiropractors are most known for performing spinal manipulation, however, other types of licensed healthcare practitioners can perform it as well.

This article provides an overview of spinal manipulation, its uses, benefits, risks, and what to expect if you receive this therapy.

Uses

Licensed practitioners primarily use spinal manipulation to relieve back pain or improve body function and mobility. This therapy involves using the hands or another device to apply force and manipulate the joints in the spine.

There are many types of licensed professionals who perform spinal manipulation, including:

• Chiropractors
• Osteopathic physicians
• Physical therapists
• Naturopathic physicians (only in certain states)

Many licensed practitioners will also prescribe or recommend other at-home self-care practices in addition to spinal manipulation.

Benefits

The most reported benefit of spinal manipulation therapy is reduced chronic back pain. However, a 2019 meta-analysis of 47 randomized controlled trials found other benefits, including improved body function and short-term pain relief.

Like many other CAM therapies, there are fewer clinical studies on spinal manipulation benefits than more traditional therapies, such as medication and surgery. Yet many people who use spinal manipulation report that they find additional benefits, though not yet proven.

Risks

Most studies report that spinal manipulation given by a licensed and trained health professional is generally safe. But as with any therapy, there is an element of risk.

The most reported side effects include temporary soreness at the manipulation site and exhaustion.

One 2017 study identified 283 reviews from spinal therapy patients and found that some rare adverse reactions can include:

• Headache
• Vertebral artery dissection
• Stroke

There may be additional risks associated with spinal manipulation of the upper cervical spine. However, that area is usually not addressed when receiving treatment for lower back pain.

The study also concluded that it's not currently possible to provide guidelines regarding the safety of spinal manipulation. Although severe or life-threatening events can occur after spinal manipulation, the study reported that it is rare, occurring in about 1 in 20,000 to 1 in 250,000 manipulations.

Preexisting health conditions may increase the risk associated with spinal manipulation and should be thoroughly discussed with your provider prior to treatment. High-quality research studies regarding the risks and benefits of spinal manipulation are needed.

What to Expect

There are over 100 versions of spinal adjustment techniques in the world. However, most practitioners will incorporate just a few or several of them into their practice.

Two common approaches include spinal manipulation and spinal mobilization.

Spinal Manipulation: High-Velocity Low-Amplitude Thrust (HVLA)

The high-velocity low-amplitude thrust is the most common technique. This technique requires a specific force from the practitioner to a specific joint which may lead to a "pop" sound. This sound is called a cavitation and is caused by a sudden release of carbon dioxide from a joint space.

Spinal Mobilization: Low-Force Chiropractic Techniques

Low-force chiropractic techniques are a gentler approach used by the therapist.

Depending on a patient's comfort level, age, size, or preference, a therapist may decide that a spinal mobilization is best. Patients who are uncomfortable with twisting or forceful thrusting may also prefer this therapy.

Many licensed professionals who use spinal manipulation also use additional therapies to complement the treatment plan, including:

• Ice
• Heat
• Electrical stimulation
• Ultrasound
• Massage
• Soft tissue techniques (active release techniques, Graston taping, cupping, flossing, dry needling)
• Functional rehabilitative exercises

Discuss treatment options with your practitioner before starting therapy to determine a plan that is right for you.

Summary

A spinal manipulation is a controlled mobilization of a specific joint and is typically done by using hands-on techniques or devices specifically designed for joint manipulations.. Some of the benefits include reduced chronic back pain, improved body function, and short-term pain relief. Most studies report that spinal manipulation given by a licensed and trained health professional is generally safe, though some side effects, like soreness, can occur.

A Word From Verywell

Back pain and other chronic musculoskeletal problems can be frustrating and even debilitating at times. Talk with your healthcare provider to see if alternative therapy methods, such as spinal manipulation, can complement your current health management plan. Sometimes the use of multiple approaches to pain management can be more effective than using a single treatment.