Spinal manipulation

Spinal manipulation is based on the theory that back pain is caused by problems with the muscles and other tissues in the spine and trunk region.

This treatment has been used to treat neck, back, and shoulder pain.

Spinal manipulation is likely to help either acute or chronic low back pain in the short-term but probably no more than other treatments such as physical therapy, exercise, or pain medicine.1

Different practitioners use different types of manipulation, ranging from massage and slow pressing or twisting to rapid movement or forceful pressure on the head, shoulders, back, or hips.

If you have tight muscles or muscles that spasm, your practitioner may first use heat, ultrasound, or electrical current to relax your muscles before manipulating the spine.

People who benefit from spinal manipulation usually notice improvement after one visit, and additional visits aren't needed.2 At most, 2 to 3 weeks of this type of treatment is considered to be enough to treat sudden 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 physical therapists also provide spinal manipulation. So do physiatrists and some other medical doctors.

Health insurance coverage varies for this type of treatment. So before you start treatment, check to find out whether your practitioner of choice is covered.

Practitioners who are not medical doctors do not use medicines or surgery to treat conditions.


  1. Chou R, Huffman LH (2007). Nonpharmacologic therapies for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine, 147(7): 492–504.
  2. Hadler NM (2005). Low back pain. In WJ Koopman, ed., Arthritis and Allied Conditions, 15th ed., vol. 2, pp. 2073–2086. Philadelphia: Lippincott Williams and Wilkins.

Last Updated: February 3, 2010

Author: Shannon Erstad, MBA/MPH

Medical Review: William M. Green, MD - Emergency Medicine & Robert B. Keller, MD - Orthopedics

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