Though spinal manipulation (often done by chiropractors) was once considered a fringe medical treatment for back pain, more and more medical doctors include the practice in their patients' treatment plans. And before patients walk into a medical doctor's office, many have already seen a chiropractor.
According to Richard Guyer, MD, a spine surgeon at the Texas Back Institute in Plano, some 60% of patients see a chiropractor before they seek out an orthopedic surgeon. So it's likely you will consider (or someone will suggest) spinal manipulation for your back pain. This straightforward guide will help you understand the treatment, the different kinds of professionals who practice it, and whether it can help you.
Key points in making your decision
Spinal manipulative therapy is adjustment of the spine using twisting, pulling, or pushing movements. These movements can loosen and move the spinal bones and joint structures that may be causing pain. This is the basis of chiropractic treatment, but not only chiropractors are trained to do spinal manipulation.
See a chiropractor, an osteopathic doctor, a physiatrist, or a physical therapist who performs spinal manipulation. Your insurance coverage may be a factor in deciding who to see for treatment.
When deciding about spinal manipulation, consider the following:
Spinal manipulative therapy is based on the theory that your spinal health is central to your overall health. It relies on spinal manipulation, or spinal manual therapy, to increase a joint's range of motion. Different practitioners use different manipulation techniques, ranging from massage and slow pressing or twisting to rapid movement or forceful pressure on the head, shoulder, back, or hips. If you have tight or spasming muscles, your practitioner may first use a technique such as heat, ultrasound, or electrical current to relax your muscles before manipulating the spine. Practitioners who are not medical doctors do not use medicines or surgery to treat conditions.
People who benefit from spinal manipulative therapy usually notice improvement after one visit, and additional manipulation is not needed. At most, 2 to 3 weeks of spinal manipulative therapy is considered to be enough to treat acute low back pain. Although some practitioners encourage long-term spinal manipulation for "maintenance" or "preventive" reasons, this practice has no proven value.
Chiropractors are not your only choice for providing spinal manipulation. Osteopathic doctors (DOs) are fully credentialed doctors whose training includes an emphasis on manual therapy. Some physiatrists and physical therapists also provide spinal manipulation. Health insurance coverage varies for this type of treatment, so it's wise to check—before starting treatment—to find out whether your practitioner of choice is covered.
Spinal manipulative therapy is adjustment of the spine using twisting, pulling, or pushing movements. These movements can loosen and move the spinal bones and joint structures that may be causing pain. This is the basis of chiropractic treatment, but not only chiropractors are trained to do spinal manipulation.
See a chiropractor, an osteopathic doctor, a physiatrist, or a physical therapist who performs spinal manipulation. Your insurance coverage may be a factor in deciding who to see for treatment.
When deciding about spinal manipulation, consider the following:
- You may need only home treatment, such as ice, moist heat, pain relievers, and mild exercise. For most people, these home treatments usually relieve low back pain within 4 to 6 weeks.
- Before you try spinal manipulation, have your symptoms evaluated. Certain symptoms, such as sharp pain, or low back pain with leg pain or numbness, can be a sign of a serious condition that needs immediate medical treatment or that could be made worse by spinal manipulation.
- You can't count on spinal manipulation alone to treat low back pain. Good spinal manipulative therapy includes self-care information and strength and conditioning exercises that help your muscles better support your troubled joints.
- If you choose spinal manipulation, find a practitioner who is willing to coordinate care with your other health professionals.
Spinal manipulative therapy is based on the theory that your spinal health is central to your overall health. It relies on spinal manipulation, or spinal manual therapy, to increase a joint's range of motion. Different practitioners use different manipulation techniques, ranging from massage and slow pressing or twisting to rapid movement or forceful pressure on the head, shoulder, back, or hips. If you have tight or spasming muscles, your practitioner may first use a technique such as heat, ultrasound, or electrical current to relax your muscles before manipulating the spine. Practitioners who are not medical doctors do not use medicines or surgery to treat conditions.
People who benefit from spinal manipulative therapy usually notice improvement after one visit, and additional manipulation is not needed. At most, 2 to 3 weeks of spinal manipulative therapy is considered to be enough to treat acute low back pain. Although some practitioners encourage long-term spinal manipulation for "maintenance" or "preventive" reasons, this practice has no proven value.
Chiropractors are not your only choice for providing spinal manipulation. Osteopathic doctors (DOs) are fully credentialed doctors whose training includes an emphasis on manual therapy. Some physiatrists and physical therapists also provide spinal manipulation. Health insurance coverage varies for this type of treatment, so it's wise to check—before starting treatment—to find out whether your practitioner of choice is covered.
Last Updated: February 6, 2008 How effective is spinal manipulation?
Like other treatments, spinal manipulation helps relieve acute low back pain for some people, but not for others. Spinal manipulation success is influenced by both the practitioner's diagnostic and treatment skill, and the cause of low back pain. Results from randomized controlled trials comparing spinal manipulation and placebo suggest that for acute low back pain spinal manipulation is more helpful than placebo in the short term. In the long term (more than 6 weeks) there was no difference between spinal manipulation and placebo. For chronic low back pain, the pain improved for more than 6 weeks, but the level of activity was the same as with a placebo.
Comparisons between spinal manipulation and other low back pain treatments have produced conflicting results, but most show that spinal manipulation is no better than usual care such as physical therapy or exercise. According to some experts, it's difficult to show that one treatment is better than another, because most low back pain improves within the first month regardless of treatment.
A UCLA study has suggested that people are nearly equally satisfied with chiropractic versus medical low back pain care when they are given clear treatment information and at least four suggestions for home treatment. (The study did not include other practitioners such as osteopaths or physical therapists.)
What are the risks of spinal manipulative therapy?
Perhaps the most common risks of seeking spinal manipulative therapy are related to a lack of standard practice in this field. Be a smart consumer (as you would be when considering a surgical or experimental back treatment). Ask your medical doctor or physical therapist to explain the risks and benefits of spinal manipulative therapy. Particularly if you have no referral, interview a practitioner or two before starting treatment.
Slow "mobilizing" movement has no known risks. But if a practitioner offers to work on your neck, remember that forceful neck manipulation, as performed by some practitioners, has been linked to rare but serious cases of neurological damage and sometimes death. Rapid neck manipulation can injure vertebral arteries, leading to stroke. It can also cause disc herniation that can lead to disability. You can avoid this type of risk with an experienced practitioner who uses slow, gentle manipulation techniques to treat carefully diagnosed conditions. Talk to your doctor or physical therapist before trying manual treatment for your neck.
If manipulation leads to increased pain or new pain in the legs or anywhere else, do not continue this treatment.
Practices to look for in a spinal manipulative therapy practitioner:
Like other treatments, spinal manipulation helps relieve acute low back pain for some people, but not for others. Spinal manipulation success is influenced by both the practitioner's diagnostic and treatment skill, and the cause of low back pain. Results from randomized controlled trials comparing spinal manipulation and placebo suggest that for acute low back pain spinal manipulation is more helpful than placebo in the short term. In the long term (more than 6 weeks) there was no difference between spinal manipulation and placebo. For chronic low back pain, the pain improved for more than 6 weeks, but the level of activity was the same as with a placebo.
Comparisons between spinal manipulation and other low back pain treatments have produced conflicting results, but most show that spinal manipulation is no better than usual care such as physical therapy or exercise. According to some experts, it's difficult to show that one treatment is better than another, because most low back pain improves within the first month regardless of treatment.
A UCLA study has suggested that people are nearly equally satisfied with chiropractic versus medical low back pain care when they are given clear treatment information and at least four suggestions for home treatment. (The study did not include other practitioners such as osteopaths or physical therapists.)
What are the risks of spinal manipulative therapy?
Perhaps the most common risks of seeking spinal manipulative therapy are related to a lack of standard practice in this field. Be a smart consumer (as you would be when considering a surgical or experimental back treatment). Ask your medical doctor or physical therapist to explain the risks and benefits of spinal manipulative therapy. Particularly if you have no referral, interview a practitioner or two before starting treatment.
Slow "mobilizing" movement has no known risks. But if a practitioner offers to work on your neck, remember that forceful neck manipulation, as performed by some practitioners, has been linked to rare but serious cases of neurological damage and sometimes death. Rapid neck manipulation can injure vertebral arteries, leading to stroke. It can also cause disc herniation that can lead to disability. You can avoid this type of risk with an experienced practitioner who uses slow, gentle manipulation techniques to treat carefully diagnosed conditions. Talk to your doctor or physical therapist before trying manual treatment for your neck.
If manipulation leads to increased pain or new pain in the legs or anywhere else, do not continue this treatment.
Practices to look for in a spinal manipulative therapy practitioner:
- Is willing to coordinate treatment with your other health professional(s)
- Provides educational information about home treatment and exercises
- Diagnoses musculoskeletal problems with physical examination and interview, using X-ray in unusual circumstances
- Is willing to refer you to a specialist when necessary, such as to an orthopedist, neurosurgeon, or oncologist for further testing, or to a registered dietitian for nutritional counseling
- Uses slow, gentle manual therapy techniques
- Uses X-rays as a standard diagnostic test, particularly full-body X-rays or X-rays of children, which give unnecessarily high levels of radiation
- Practices based on the unproven theory that "subluxation" (partial dislocation of two joint surfaces) is responsible for many medical diseases
- Uses joint manipulation to treat such conditions as respiratory and ear infections, skin conditions, eye problems, and learning disabilities
- Promotes long-term spinal manipulative therapy to prevent illness or joint problems
- Sells other products or services, such as herbal or dietary supplements or counseling, without proper training and credentials