Spinal Manipulation for Back and Neck Pain: Does It Work?

Laird Harrison


February 15, 2017

In This Article

Unknown Mechanisms of Action

Researchers have distinguished between manipulation and mobilization. Anita Gross, the Canadian researcher, describes mobilization as a "slow, sustained, or repeated type of movement." Most of what massage therapists do fits into this category. Manipulation, on the other hand, is "a more high-velocity quick stretch at the end of a range." Chiropractors are particularly associated with this type of therapy.

No one knows for sure why spinal manipulation works. Palmer said chiropractic manipulation corrects subluxations—misalignments of vertebrae that impinge nerves. Dr Still contended that osteopathic manipulation improved circulation.

Contemporary theories on the mechanism of spinal manipulation include the disruption of articular or periarticular adhesions; release of entrapped synovial folds; unbuckling of motion segments that have undergone disproportionate displacements; relaxation of hypertonic muscle; alteration of mechanoreceptors in the spinal apophyseal joints; and release of endorphins.[6]

However spinal manipulation works, it's at least better than nothing when it comes to chronic low back pain, says Dr Chou. "Our general finding was that manipulation appears to be more effective than treatments that are thought to be basically control treatments—such things as pretend ultrasound or giving somebody an educational booklet," he explains.

It's hard to say whether spinal manipulation is significantly better than other noninvasive, active treatments for chronic low back pain. Effect sizes for all of these therapies are small. Spinal manipulation "seems to be similar in effectiveness to such things as exercise, which is probably the thing that it has been most commonly compared with," Dr Chou says.

The few trials that looked at radicular low back pain, however, found that spinal manipulation was not effective.

The effects of spinal manipulation appeared to be not only modest but also short in duration. And there was some evidence that spinal manipulation might work best in combination with other therapies.

For example, in one trial that Dr Chou says was good-quality, patients who had spinal manipulation plus home exercise and advice reported after 12 weeks that their pain was about 1 point lower on a scale of 0-10 than did patients who exercised and got advice without spinal manipulation. After 1 year, though, the difference faded to less than 0.7 point and was no longer significant.[2]


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