Spinal Manipulation: Not Just for Chiropractors


Chiropractors are a common healthcare profession within the global healthcare system; in fact, it is estimated that 30-40 million Americans see a Chiropractor each year. Chiropractors are trained and licensed individuals who specialize in advanced manual therapy and spinal manipulation techniques to address misalignment of joints. A Chiropractic “adjustment” is commonly a form of Spinal Manipulation Therapy. Spinal Manipulation Therapy also known as High Velocity Low-Amplitude Thrusts (HVLAT) is an intervention also utilized by other care professionals including Physical Therapists and Osteopathic Physicians.

Physical Therapists are trained in various manual therapy techniques including spinal mobilization and manipulation.
Spinal Mobilization is a low velocity technique performed in various positions to produce a therapeutic effect. These techniques are not generally associated with audible cavitation, popping sounds or “cracks”. Patients are often able to guard against or resist these movements.
Spinal Manipulation involves applying a controlled high velocity low-amplitude thrust force to the spine or an extremity to improve mobility and relieve pain. The thrusting force promotes joint surface separation and is commonly accompanied by an audible cavitation, popping or the much desired “crack”.

Benefits of Spinal Manipulation
The goal of spinal manipulation is to restore joint mobility, reduce pain, and improve function. When performed by a trained and licensed Physical Therapist, spinal manipulation is a safe and effective treatment option for many people with musculoskeletal pain. Research has shown that spinal manipulation can be an effective treatment option for many people with the following conditions:
• Low back Pain
• Neck pain
• Headaches
• Sciatica

The benefit of spinal manipulation therapy is that it is non-invasive and can provide immediate relief to pain and improve function without the use of injections or pain medication. This makes spinal manipulation an attractive alternative for those patients looking to avoid the side effects associated with other interventions.
Similar to other PT interventions, spinal manipulation is not without some risk. The more common and minor risks of spinal manipulation normally resolve within 24 hours after the manipulation.

Common/Minor Risks of Spinal Manipulation
• Soreness or increased stiffness in the treatment area
• Headaches

In rare cases more serious side effects can occur following spinal manipulation, including stroke, nerve damage and fractures. These more serious side effects are generally linked to underlying health conditions such as spinal cord compression, spinal instability and osteoporosis. Physical Therapists are trained to screen for these risk factors and will discuss any concerns prior to performing the intervention.

It is important to note that not all Physical Therapists use manual therapy techniques that involve HVLAT. Some therapists may use gentler techniques, such as mobilization or soft tissue massage, to achieve similar results. If you have concerns about spinal manipulation or are uncomfortable with the popping or cracking sounds, it is important to discuss your options with your provider. They can work with you to find a treatment approach that is comfortable and effective for you.

Spinal manipulation is a safe and effective treatment option for many people with musculoskeletal pain. If you are considering spinal manipulation as a treatment option, it is important to discuss the risks and benefits with your physical therapist to determine if it is the right treatment option for you.
The next time you feel your neck or back pain flare up consider having your Physical Therapist take a crack at it first!