Spinal manipulation is a popular treatment in chiropractic care. Proponents of spinal manipulation claim that it can heal not only lower back pain, but also improve your overall well-being.
Since I do CrossFit and continuously suffer from minor injuries and pain, I wanted to find scientific evidence and answers to the question: “Does spinal manipulation work?” More specifically, I wanted to understand:
- For what conditions does spinal manipulation work?
- Can spinal manipulation influence the nervous system, blood flow, etc.?
- What are the risks associated with such treatments?
The short answer is that spinal manipulation may provide relief for a few conditions, such as lower back pain. However, there is no scientific evidence that it improves your overall health or wellbeing.
In other words, spinal manipulation is not the cure for all ailments the human body may suffer from. For instance, if you regularly suffer from a cold because of a weak immune system and your chiropractor suggests adjusting your spine, I’d turn around and leave.
Considering the non-existent evidence of the benefits of spinal manipulation for anything but certain types of pain, I have focused the remainder of this article on those areas, especially lower back pain.
What is Chiropractic?
Chiropractic care falls into the category of alternative medicine. It got its name from the two Greek words for hand (cheir) and practice (praxis). In other words, chiropractic follows a hands-on approach, and it focuses on the diagnosis and treatment of mechanical disorders related to the relationship between the body’s structure and its functioning.
Many think chiropractic care is synonymous with spinal manipulation, which isn’t true.
Chiropractic and Chronic Back Pain
There are more than 200 available treatments for chronic back pain in the market. A recent study of them listed pharmacological therapies, manual therapy, exercise, physical-, educational-, and psychological modalities, minimally invasive techniques, surgery, lifestyle changes, and alternative medicine.
Every single one of them may prove to be useful, but none is tagged as the number one, superior treatment (1). That is because the correct treatment depends on the cause of your problem, among other things.
Spinal manipulation is one of the options the authors listed in the study mentioned above. Yet it’s still a controversial approach to treat back pain that not all healthcare providers accept as an effective treatment. Still, spinal manipulation enjoys broad popularity, not only for back pain but also neck pain and other health problems.
Studies show that no less than 30% of patients with pain associated with their spine or back seek a chiropractor, and more than half (59%) report to be highly satisfied with the treatment. That is even more than those who visit a physical therapist (55%) or a primary care physician (34%) (2,3). But leaving people’s satisfaction rate aside, what does the science have to say? Is spinal manipulation effective and does it work?
Is Spinal Manipulation The Real Deal?
People have biased opinions, and what helps your neighbor does not necessarily work as an effective therapy for you. To reach an agreement between people’s perceptions and actual results, we have developed a scientific method that evaluates how effective treatments are while leaving aside personal emotions, inaccurate recollections, or bias.
Moreover, scientists use a process called a systematic review and meta-analysis, which analyzes an extensive collection of studies on the same subject. The goal is to gather all possible data to understand better how proposed solutions (i.e., a treatment) work to solve a problem (i.e., a medical condition).
Meta-Analysis On The Effectiveness Of Spinal Manipulation
In 2017, one of these systematic reviews reported how effective spinal manipulation is. The authors published their findings in the Journal of the American Medical Association (JAMA) under the name “Association of Spinal Manipulative Therapy with Clinical Benefit and Harm for Acute Low Back Pain.”
After analyzing 26 different clinical trials, the authors concluded that spinal manipulation therapy does improve pain, at least modestly, in patients with lower back pain by causing a significant and measurable change. They also reported that there was enough evidence to say that spinal manipulation improves spinal function, measured by movement and how it affects the quality of life (4).
Taking a closer look at that study, we can see that while some patients gained substantial benefits from spinal manipulation, others experienced only a small change or none at all. In other words, spinal manipulation worked for some patients and not for others.
That’s why many studies list spinal manipulation as a “low-quality evidence therapy.” As a result, most physicians say that you should treat spinal manipulation for what it is: a complementary therapy that does not replace a formal visit to your physiotherapist or primary care provider.
Moreover, the guideline from the American College of Physicians concludes that low back pain improves after a while, regardless of the therapy that’s been used to alleviate the pain (5). In other words, regardless of what you do, the pain will go away eventually.
The guideline also recommends patients and their caregivers to consider non-pharmacological approaches first to relieve acute or subacute back pain, counting in alternative therapies such as the application of heat, acupuncture and spinal manipulation. Ultimately, any method that reduces back pain is useful and will improve the quality of life while your body heals naturally.
Spinal Manipulation – A Cure For All Ailments?
While there are valid uses cases for spinal manipulation, such as lower back pain, the treatment has gotten a bad reputation among the scientifically literate community because some chiropractors claim their technique holds exceptional benefits, including improvements in blood levels, better control of chronic diseases like diabetes and hypertension, cardiovascular risk reduction, and improvements in thyroid disease.
However, all of these claims lack sufficient scientific evidence, and there is no biological rationale behind them. So, let’s take a look behind the hypothesis of spinal manipulation, and how chiropractors apply it.
How Does Spinal Manipulation Work To Relieve Pain?
The fundamentals of spinal manipulation are based on anatomic and physiologic principles, and the improvements patients experience might as well account for its feasibility (6,7). The hypothetical reasons why spinal manipulation works to relieve pain are as follows:
- It restores the mobility and flexibility of facet joints: The articulations between one vertebra and the other is called a facet joint. Sometimes they experience inflammation, and swelling which causes muscle spasms and limitations in flexibility and movement. Some chiropractic techniques improve the reactive contractions and help regain the normal functioning of facet joints.
- Repositioning of discs and bulging material: Herniated discs, bulging discs, and pinched nerves are a common cause of back pain. Chiropractic therapies create a negative pressure inside the disc which helps to bring back the bulging or herniated material.
- Reducing muscle tension: Pressure applied during a chiropractic session improves muscle tension. The latter is sometimes the sole reason for acute back pain, especially when it is the result of daily stress and poor posture.
- Breaking fibrous adhesions around the spine: Sometimes, fibrous adhesions and scar tissue forms around the spine or a herniated disc, which results in pain around the adjacent vertebrae. Spinal manipulation uses passive stretches and other maneuvers to reduce movement limitations caused by spinal adhesions.
- Neurophysiological effects: There are certain nerves that carry an inhibitory signal to reduce the sensation of pain when it is too much and too prolonged. Spinal manipulation is thought to induce changes in the nervous system by increasing inhibitory reflexes that reduce the sensation of pain.
- Other possible reasons why it works: Asides from these hypothetical mechanisms of action, chiropractic therapy also works by relying on its high-touch nature. The growing patient-clinician relationship, which builds over repeated visits, the empowerment, enthusiasm and reassurance patients feel after leaving the chiropractic’s room, and their conviction that spinal manipulation will help, all contribute to patients’ satisfaction with the treatment. All of these have a powerful effect by relaxing muscles and releasing neurotransmitters to inhibit the sensation of pain.
Is Spinal Manipulation Safe For Me?
When revisiting the literature related to spinal manipulation, we often come across case reports questioning the safety of this procedure. These reports contribute to the hesitancy of clinicians to consider chiropractic therapy as a viable option to relieve pain.
According to a recent review of the scientific literature, there’s no agreement about the safety of spinal manipulation. Some authors suggest it is safe, while others point out severe complications and conclude that medical professionals should not utilize it.
However, the higher quality studies conclude that spinal manipulation is safe, or at least less harmful than its critics suggest. The truth is that most side effects are minor events, such as soreness. But there are reports of spinal cord injury and other major problems (8).
It is difficult to predict if chiropractic therapy might cause adverse effects instead of solving the underlying problem. Based on my findings, I conclude that the risk of injury or complications is the highest for procedures involving the neck region.
The risk for procedures involving the lumbar area is relatively low, and injuries in the lumbar spine are extremely rare, which makes this technique more appropriate and safe to control low back pain (8).
How Does It Compare To Conventional Treatments?
Conventional treatments often include non-steroidal anti-inflammatory drugs (NSAIDs) or opioids. Such medication often has side-effects that could negatively impact your gastrointestinal and renal systems.
According to studies, people who take NSAIDs have a higher risk of renal abnormalities (9), ulcers and gastric erosion (10), but many patients still routinely use them to manage pain. In contrast, spinal manipulation is a safe treatment option for low back pain, and it has been proven to make a difference in a significant number of patients.
How Much Are Treatments Involving Spinal Manipulation?
Spinal manipulation is a treatment that usually requires several visits to your chiropractor, depending on how severe your condition is. At a glance, chiropractic treatment seems to be much more expensive than conventional treatments involving NSAIDs.
However, if we consider the potential side-effects of pain medications, the cost of additional drugs to counter those side-effects, as well as the expenses related to pharmacological complications and check-ups, the cost of chiropractic care is comparable to conventional methods.
Previous reviews about the costs of medical attention reported that patients who received traditional medical care had almost the same expenses as those who seek alternatives, such as chiropractic care (2).
Tension Myositis Syndrome
I recently learned about a condition called Tension Myositis Syndrome (TMS), also known as tension myoneural syndrome or mind-body syndrome. Dr. John Sarno, a doctor at the New York University who died in 2017, coined those terms.
The condition involves mental triggers that can reduce blood flow to specific muscles in the lower back area. That reduced blood flow can cause muscle spasms or malfunctions that patients might experience as back pain.
In other words, Dr. John Sarno suggested that psychological issues can express themselves physiologically. Dr. Mikhail “Mike” Varshavski explained the concept very well in a YouTube video I have linked here.
Conclusion – Does Spinal Manipulation Work?
The scientific community has started to acknowledge spinal manipulation as an effective therapy to manage certain types of pain. That includes specifically lower back pain.
The reviews and meta-analyses of the scientific papers published so far have revealed that chiropractic care may provide benefits to some and none to others. In other words, it’s as effective or ineffective as any other treatment, including not doing anything at all.
Considering all of the evidence, it seems that spinal manipulation techniques are a reasonable treatment. Compared to NSAIDs it offers similar benefits with less adverse side-effects when treating low back pain.
There are case reports of injuries involving the upper spine and neck area, so I’d recommend staying away from the thoracic region until there is more information to assess the associated risk accurately.
As always, I appreciate your feedback. Especially if you have new evidence, such as peer-reviewed studies or meta-analysis that I haven’t considered, send them my way!