Everything You Need to Know About Spinal Manipulation

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Spinal manipulation therapy involves using the hands or another device to apply force to manipulate the joints in the spine. This form of therapy aims to improve mobility to relieve ailments such as lower back pain. Chiropractors are most known for performing spinal manipulation, however, other types of licensed healthcare practitioners can perform it as well.

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

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

There are many types of licensed professionals who perform spinal manipulation, including:

Many licensed practitioners will also prescribe or recommend other at-home self-care practices in addition to spinal manipulation.

CAM Therapy

Spinal manipulation therapy is a form of complementary and alternative medicine (CAM) therapy. It's the most widely used CAM therapy for children and adults in the United States.


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

Like many other CAM therapies, there are fewer clinical studies on spinal manipulation benefits than more traditional therapies, such as medication and surgery. Yet many people who use spinal manipulation report that they find additional benefits, though not yet proven, including:

  • General wellness
  • Disease prevention
  • Improved energy
  • Better immune function
  • Improve memory or concentration

In the United States, about 67% of adults who use osteopathic or chiropractic manipulation say they use it to treat a certain health condition that they already have. About 53% use it as a preventive therapy and for overall wellness.


Most studies report that spinal manipulation given by a licensed and trained health professional is generally safe. But as with any therapy, there is an element of risk.

The most reported side effects include temporary soreness at the manipulation site and exhaustion.

One 2017 study identified 283 reviews from spinal therapy patients and found that some rare adverse reactions can include:

There may be additional risks associated with spinal manipulation of the upper cervical spine. However, that area is usually not addressed when receiving treatment for lower back pain.

The study also concluded that it's not currently possible to provide guidelines regarding the safety of spinal manipulation. Although severe or life-threatening events can occur after spinal manipulation, the study reported that it is rare, occurring in about 1 in 20,000 to 1 in 250,000 manipulations.

What to Expect

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

Two common approaches include spinal manipulation and spinal mobilization.

Spinal Manipulation: High-Velocity Low-Amplitude Thrust (HVLA)

The high-velocity low-amplitude thrust is the most common technique. This requires force from the therapist that often leads to a "pop" sound. This sound is a result of sudden force being applied to a joint while positioned in a certain way.

Spinal Mobilization: Low-Force Chiropractic Techniques

Low-force chiropractic techniques are a gentler approach used by the therapist.

Depending on a patient's comfort level, age, size, or preference, a therapist may decide that a spinal mobilization is best. Patients who are uncomfortable with twisting or forceful thrusting may also prefer this therapy.

Many licensed professionals who use spinal manipulation also use additional therapies to complement the treatment plan, including:

  • Ice
  • Heat
  • Electrical stimulation
  • Ultrasound
  • Massage

Discuss treatment options with your practitioner before starting therapy to determine a plan that is right for you.


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

  • Any risk of significant bone weakening
  • Neurological issues, like cord compression or pinched nerves
  • Vascular or bleeding conditions
  • Positioning can't be achieved because of pain or resistance


Spinal manipulation involves hands or other devices manipulating joints in the spine in a way that they don't naturally do on their own. Some of the benefits include reduced chronic back pain, improved body function, and short-term pain relief. Most studies report that spinal manipulation given by a licensed and trained health professional is generally safe, though some side effects, like soreness, can occur.

A Word From Verywell

Back pain and other chronic musculoskeletal problems can be frustrating and even debilitating at times. Talk with your healthcare provider to see if alternative therapy methods, such as spinal manipulation, can complement your current health management plan. Sometimes the use of multiple approaches to pain management can be more effective than using a single treatment.

Frequently Asked Questions

  • Is spinal manipulation safe?

    Most studies report that spinal manipulation given by a licensed and trained healthcare professional generally is safe. But as with any therapy, there is some degree of risk. The most reported side effects are temporary soreness at the manipulation site, tiredness, and headache. Rare but serious effects can include vertebral dissection and stroke.

  • How long does spinal manipulation take?

    The appointment usually lasts about 30 minutes. However, the spinal manipulation itself will take less time. The initial intake visit can take up to an hour or longer because you will need to discuss your health history and objectives for care.

  • Can you align your own back?

    It's not recommended and may be unsafe to try to align your own back without the assistance of a licensed and trained healthcare professional. It's often impossible to know what areas specifically need attention without diagnostic information, such as an X-ray. It's also possible to hurt yourself while attempting self-alignment.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Center for Complementary and Integrative Health. Spinal manipulation: what you need to know.

  2. National Institute for Complementary and Integrative Health. Four things to know about spinal manipulation for low back pain.

  3. Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trialsBMJ. 2019;364:l689. doi:10.1136/bmj.l689

  4. Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews.  Syst Rev. 2017;6(1):64. doi:10.1186/s13643-017-0458-y

  5. Spine Health. Understanding spinal manipulation.

  6. Physiopedia. Spinal manipulation.

By Sarah Jividen, RN
Sarah Jividen, RN, BSN, is a freelance healthcare journalist and content marketing writer at Health Writing Solutions, LLC. She has over a decade of direct patient care experience working as a registered nurse specializing in neurotrauma, stroke, and the emergency room.