Spinal manipulation is the most misunderstood treatment in the rehab world. Many chiropractors, PTs, and osteopaths don’t really understand how spinal manipulation works (and why).
So here’s the truth.
Spinal Manipulation 101
Let’s start with the basics of spinal manipulation therapy (SMT).
First, it’s a hands-on manual therapy technique applied to the spine. Spinal manipulation involves a short, quick “thrust” force applied to the target spinal joint(s). This often produces an audible “pop” or “crack” from the spine, called a cavitation.
The main goal of SMT is pain relief and improved mobility at the treated area. Chiropractors, physical therapists, and osteopaths (medical doctors with DO credentials) are the most common practitioners of spinal manipulation. Even if many don’t understand how spinal manipulation works.
All The Myths
Spinal Manipulation works. But why?
Plenty of myths surround this treatment. Let’s bust a few.
1. Manipulation Re-Aligns the Spine
Manipulation doesn’t reposition the spine in any meaningful way. A chiropractic journal recently called this re-alignment concept a “common and outdated misconception.”
Related: 5 Problems with Spinal Alignment Theory (Article)
2. Getting a Loud “Pop” Matters
Many manual therapists attempt to elicit a loud cavitation during spinal manipulation. While this phenomenon often occurs, any additional benefits from a “pop” are likely psychological.
3. Skilled Clinicians Target the Problem Joint
Research on both chiropractic and oesteopathic techniques reveal that audible cavitations occur, on average, 1 joint above or below the targeted area – but as far as 4 vertebral segments away!
4. SMT has Magic Powers
The are a host of myths under this umbrella – mostly from old school chiropractic and osteopathic schools of thought.
For example, some clinicians believe spinal manipulation restores normal nerve conduction along the spine, improves immune system function, or helps with allergies. These claims are all false.
In reality, most (if not all) effects from SMT are neurophysiological – influencing the nervous system to reduce pain and improve movement.
There are a host of neurological and physiological changes that explain how spinal manipulation works. A few examples include reduced central sensitization, activating endogenous opioid and cannabinoid pain-relief systems, changing brain neuroplasticity, and pain modulation via descending inhibitory pathways.
Best Practice
Science-based guidelines recommend spinal manipulation for low back pain and mid back pain, especially when joint stiffness is a dominant feature.
Neck manipulation is a bit more complicated due to the rare but known risk of artery damage and stroke linked to cervical spine manipulation.
Overall, exercise-based treatments work best for back pain, and manual therapies like SMT offer additional benefits. However, SMT is not a strong stand-alone treatment.
Further Reading
Want to see how your favorite treatments stack up?
Check out: Ranking Physical Therapy Treatments from Worthless to Elite (Article)
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