Everything you need to know about spinal manipulation

Spinal manipulation involves using the hands or other devices to apply force to manipulate the joints in the spine. This form of treatment is designed to improve mobility to relieve conditions such as low back pain. Chiropractor Best known for performing spinal manipulations, however, other types of licensed healthcare practitioners can perform it as well.

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


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

There are many types of spine manipulations performed by licensed professionals, including:

  • Chiropractor
  • Orthopedist
  • physical therapist
  • Naturopathic physician (in some states only)

In addition to chiropractic, many licensed practitioners prescribe or recommend other home self-care practices.

CAM therapy

Chiropractic is a form of Complementary and Alternative Medicine (CAM) therapy. It is the most widely used CAM therapy for children and adults in the United States.


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

As with many other CAM therapies, there are fewer clinical studies on the benefits of spinal manipulation compared to more traditional therapies such as drugs and surgery. However, many people who use chiropractic report that they find additional benefits, albeit unproven, including:

  • general health
  • prevent disease
  • improve energy
  • better immune function
  • Improve memory or concentration

About 67 percent of adults in the U.S. who use osteopathy or chiropractic say they use it to treat a health condition they already have. About 53% use it for preventive treatment and overall health.


Most studies report that spinal manipulations performed by licensed and trained health professionals are generally safe. But as with any therapy, there are risk factors.

The most reported side effects include temporary soreness and fatigue at the procedure site.

A 2017 study identified 283 reviews from chiropractic patients and found that some rare adverse reactions may include:

  • headache
  • vertebral artery dissection
  • stroke

Spinal manipulation of the upper cervical spine may carry additional risks. However, when receiving treatment for low back pain, this area is usually not treated.

The study also concluded that no current guidelines on the safety of spinal manipulations are available. Although serious or life-threatening events can occur after spinal manipulation, the study reported that this is rare, occurring between 1 in 20,000 and 1 in 250,000 procedures.

what to expect

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

Two common methods include spinal manipulation and spinal mobilization.

Spinal Manipulation: High Speed ​​Low Amplitude Thrust (HVLA)

High-speed low-amplitude thrust is the most common technology. This requires the strength of the therapist, which often results in a “pop” sound. This sound is the result of a sudden force on the joint when positioned in a certain way.

Spine Mobilization: Low-Force Chiropractic Techniques

Low-force chiropractic techniques are a gentler method used by therapists.

Depending on the patient’s comfort, age, size, or preference, the therapist may decide that a spinal mobilization is best. Patients who are uncomfortable with twisting or strong thrusts may also prefer this therapy.

Many licensed professionals who use chiropractic also use other therapies to supplement the treatment plan, including:

  • ice
  • hot
  • electrical stimulation
  • Ultrasound
  • massage

Discuss treatment options with your doctor before starting treatment to determine which plan is right for you.


Spinal manipulation is not for everyone. A physical therapist will evaluate any contraindications (reasons why this treatment should not be used because it may cause harm), including:

  • risk of any significant bone weakening
  • Nervous system problems, such as a compressed umbilical cord or a pinched nerve
  • blood vessel or bleeding condition
  • Unable to locate due to pain or resistance


Spinal manipulation involves hands or other devices manipulating joints in the spine in ways that they do not naturally operate on their own. Some of the benefits include reduced chronic back pain, improved physical function and short-term pain relief. Most studies report that spinal manipulation by a licensed and trained health professional is generally safe, although some side effects, such as pain, may occur.

VigorTip words

Back pain and other chronic musculoskeletal problems can be frustrating and even debilitating at times. Talk to your healthcare provider to find out if alternative therapies, such as chiropractic, can complement your current health management plan. Sometimes, using multiple pain management methods may be more effective than using a single treatment.

Frequently Asked Questions

  • Is Spinal Manipulation Safe?

    Most studies report that spinal manipulations performed by licensed and trained healthcare professionals are generally safe. But as with any therapy, there is a certain level of risk. The most reported side effects were temporary soreness at the procedure site, tiredness, and headache. Rare but serious effects may include vertebral dissection and stroke.

  • How long does spinal manipulation take?

    Appointments usually last about 30 minutes. However, the spinal manipulation itself will take less time. The initial visit can take an hour or more as you discuss your health history and goals of care.

  • Can you align your back?

    Attempting to align your back without the help of a licensed and trained healthcare professional is not recommended and may be unsafe. Without diagnostic information, such as X-rays, it is often impossible to know which areas require special attention. You can also hurt yourself when trying to adjust yourself.