What is Spinal Manipulation?

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  • Written By: Sheri Cyprus
  • Edited By: C. Wilborn
  • Last Modified Date: 07 October 2019
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Also called spine adjustment, spinal manipulation is a therapeutic treatment of the spine to relieve back or neck pain. The practice is thought to date back to the ancient Egyptians. The spine's discs are moved, or manipulated, by physical therapists, chiropractors, or osteopathic physicians. Spinal manipulation is often called cracking the joints due to the often loud popping sounds that result; in reality no bone, discs, or cartilage snaps or breaks to create the loud noise, but rather it is made by escaping air or gas bubbles. Arthritic joints do grind together to create some noise; arthritis is joint inflammation that wears away the smooth cartilage cushioning.

While spinal manipulation may relieve neck or back pain in many cases, the pain-relieving effects may not always be long-lasting. There is also the possibility of spinal manipulations causing a stroke, although this risk is considered rare. Harsh twisting, rather than gentle manipulations of the spine's discs, has the most risk for damage.

Health professionals licensed to perform spinal manipulation often use a gentle approach that may include massaging the spine before manipulating it with the hands or medical tools. Chiropractors and other professionals should conduct a physical examination to check for joint inflammation and disc misalignment before adjusting the spinal column. Subluxation refers to the limited movement and other symptoms caused by the misalignment of the joints. Muscle tone may be affected in subluxation; the joints are often painful and tender.


Spinal manipulation is often done on a padded table. Depending on the part of the spinal column affected, the movements could involve large adjustments of the whole spine or small manipulations of individual discs. Stretching and massaging are other techniques used with spinal manipulations. People who are sedentary, or spend a large amount of time sitting, are susceptible to lower back pain due to excess pressure on the spine.

Daniel D. Palmer started the world's first chiropractic college in Davenport, Iowa in 1897. Since then, many others, including college alumni and Palmer's son, B.J., developed the chiropractic discipline. Mainstream medicine hasn't always accepted the chiropractic model or agreed on the concepts of subluxation and spinal manipulation. Chiropractors assert that the medical manipulation of the spinal column does work, but must be done clinically by trained chiropractic professionals. Most chiropractors state that self-manipulation of the joints, such as what is known as neck or knuckle cracking, can be harmful as it may stretch a joint in a way that causes swelling or damage.


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Post 8

I don't really agree with the idea of spinal manipulation. I just don't think it works. My mom has been going to a chiropractor for years and while she insists that it helps her, she still has back problems.

I don't think any treatment that you have to keep doing over and over is really effective. If it were that effective, you would only need to go a few times, and then you'd be done!

Post 7

@SkyWhisperer - I've had spinal manipulation done by several different chiropractors over the years, and they all had slightly different techniques. But guess what? They all made me feel better!

I think spinal manipulation technique depends on how the individual chiropractor prefers to practice. I went to one chiropractor that used a little tool to do the spinal manipulations and another that took a more hands on approach. Both were fine, but from what I understand using a tool is bit more up to date way of doing it.

Post 6

I've had spinal manipulation therapy done, as well as other chiropractic treatments (chiropractors can help with more than just your back). I think it's very effective.

In fact, I think it's so effective I keep trying to convince my step father to go. He has some back problems and I think he could really benefit from going, but he just won't.

Like one of the commenter below said, a lot of people have serious misconceptions about chiropractic. They think it's not a real medical treatment, or that it's scary, or just plain ineffective based off of stuff they've heard secondhand. I think it's one of those things you really need to try for yourself.

Post 5

@everetra - I’m on the fence about the whole practice. I’ve heard that for some people who’ve received spinal manipulation low back pain has been greatly alleviated.

But could they have been helped with a simple back massage as well, since you’re not really altering the disc location? I don’t know. I do believe that if you have serious problems like a hernia, you should go in for surgery, not chiropractic.

Post 4

@David09 - I think a lot of confusion comes from the perceptions people have about what actually happens in chiropractic spinal manipulation. Some people think that subluxation means that your discs are being literally moved.

This is not the case at all, and I would be suspicious of any professional who made that suggestion. It’s just like the article says; it’s an escape of compressed air which causes the snapping sound, not a physical realignment of the discs. I think subluxation is pretty sound as a concept, personally.

Post 3

@SkyWhisperer - It’s established science. Yes, there are so-called debunkers out there. They will show you a spinal manipulation video from one chiropractor to the next, attempting to prove that they all have their different approaches.

But I would argue that you could do that with a regular medical doctor – same patient, different diagnosis from one doctor to the next. Isn’t that what we mean by the phrase “I’ll get a second opinion”?

My wife suffered from neck pain for many years and has been greatly helped by getting a chiropractic adjustment. The insurance even covers it, after the deductible has been met. She has gotten a lot of relief from her pain. For me, that’s all the evidence that I need.

Post 2

Does spinal treatment actually work? It’s a controversial issue. One time I watched a news program on television that “exposed” the practice of chiropractor.

They went with hidden cameras to different chiropractors and showed how they all came up with different approaches to spinal manipulation for the same patient.

Some of them showed X-rays of the patient’s spine where they explained that it was shaped like an “S” which was supposedly abnormal and therefore needed to be fixed. The news program then interviewed medical doctors who said that the whole chiropractic system was fake science.

Anyway, as you can imagine, after this so-called expose, the news program was flooded with thousands of angry emails by viewers claiming that they had been helped by the chiropractic profession and that it was sound, viable medical science. I have never been to a chiropractor so I can’t speak from experience, but I do get neck pain from time to time.

Post 1

Spinal therapy can also be helpful for pregnant women! A friend of mine had a baby who was breech and she saw a chiropractor trained in the Webster technique, which is a special chiropractic technique designed to encourage baby to turn. In her case, it was effective. She was excited to be able to avoid ECV (external cephalic version, I think it stands for?), which is where they try to turn the baby manually. It can be very uncomfortable and there can be complications.

Some women also swear by chiropractic to help sunny-side-up babies turn. They are supposed to be facing your back, but sometimes they face front or sideways in there. The website Spinning Babies talks about some chiropractic techniques that are supposed to relax the right ligaments to help baby settle down better.

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