Spinal Manipulation Therapy

Spinal manipulation, also known as chiropractic adjustment, is the application of a single, high velocity thrust to joints in order to gap or move the joint very quickly. It is usual practice to get the person receiving the manipulation into a position where the joint is already at or near the end of its normal range of movement. Therefore a manipulation will often start with the health care professional moving the patient into a certain position before manipulating. This requires skilful and sympathetic handling.

Different people are qualified to manipulate: :

  • chiropractors

  • osteopaths

  • physiotherapists are also trained in this technique and some use it frequently.

  • Some orthopaedic doctors

How does spinal manipulation work?

The aim of spinal manipulation is to:

  • reduce pain
  • relieve muscle spasm
  • increase movement of a stiff area and
  • normalise movement and function

However, there is some controversy about how it actually works.

image of spinal manipulationThe idea that a joint s 'out of place' and needs to be 'put back in' is frequently encouraged by some professionals. I meet people all the time who say they have had their backs 'put back'. This implies that there is a degree of subluxation or misalignment of the joint. This has yet to be definitively proven (1) even though many chiropractors base their practice on identifying this subluxation with x-ray and then manipulating the joint ‘back in to place’.

It is very likely that spinal manipulation reduces pain as a result of changes in the nervous system.

Does it give lower back pain relief?


A systematic review is a type of research article where you gather together lots of single research trials, screen them for quality and look at all the results together if you can. This gives you a much bigger pool of results to look at and generally gives a more reliable result.

There are two published high quality systematic reviews on manipulation. The first is from 2011 and looks at chronic pain (5), the second is a similar study looking at acute pain (4).

Neither of the reviews found lots of high quality evidence to draw on but from what they they did find that there was little clinically significant difference between manipulation and various other types of treatment.

My message remains the same - it may help, try it if you and your doctor feel it is the right thing for you.

RESEARCH up to 2010

There has been a great deal of controversy about this but a large trial undertaken in the UK in 2004 (2) and a newer systematic review (3)  seem to show that manipulation achieved a small benefit which improved to a moderate benefit when combined with lower back exercises.

There are some other considerations however, the UK Beam Trial (2) only included patients who had had painful symptoms for at least a month and excluded patients who had attended a pain management programme i.e. chronic sufferers.

There is something else to be aware of too. We know that fear of movement increases the risk of you becoming disabled from back pain. The UK BEAM trial found that fear of movement lessened more with exercise than with spinal manipulation which showed only a tiny improvement. So, if you are fearful of movement at all, exercise is better for you than manipulation. Otherwise, perhaps consider both!


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1. Grieve G 1988, "Principles of Treatment," in Common Vertebral Joint Problems, Churchill Livingstone, p. 521.

2. UK BEAM Trial Team 2003, "UK Back pain Exercise and Manipulation (UK BEAM) trial - National randomised trial of physical treatments for back pain in primary care: Objectives, design and interventions (ISRCTN32683578)", BMC Health Services Research, vol. 3, no. -, pp. 1-13.

3. Ernst, E. & Canter, P. H. 2006, "A systematic review of systematic reviews of spinal manipulation", Journal of the Royal Society of Medicine, vol. 99, no. 4, pp. 192-196.

4. Rubinstein, S.M. et al., 2012. Spinal manipulative therapy for acute low-back pain. In Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008880.pub2/abstract

5. Rubinstein, S.M. et al., 2011. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews (Online), 2, p.CD008112.




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