Spinal Manipulation

Spinal manipulation is a technique where practitioners use their hands or a device to apply a controlled thrust to a joint of your spine. The amount of force can vary, but the thrust moves the joint more than it would on its own. Spinal manipulation is different from spinal mobilization, which doesn’t involve a thrust, is performed within a joint’s natural range of motion, and can be controlled by the patient.

Most spinal manipulations are done by chiropractors (chiropractic treatment often involves spinal manipulation), although other licensed professionals including osteopathic physicians and physical therapists also use this technique.

Who uses spinal manipulation and has usage changed?

In 2017, 10.3 percent of U.S. adults received chiropractic care (which usually involves spinal manipulation) during the past year, compared to 9.1 percent in 2012, according to National Health Interview Survey data from the 2 years. The 2017 data show that women were more likely than men to have visited a chiropractor and that people in the 45-to-64 age range were more likely than older or younger adults to have seen one during the past year. According to the same national survey (by the Centers for Disease Control and Prevention’s National Center for Health Statistics), non-Hispanic White adults were much more likely to have visited a chiropractor (12.7 percent) than Hispanic (6.6 percent) or non-Hispanic Black (5.5 percent) adults in 2017.

Among children, there was no significant difference in the use of chiropractic care between 2012 and 2017 (3.5 percent versus 3.4 percent). Older children (age 12 to 17) were more likely than younger ones (age 4 to 11) to have seen a chiropractor, but there was no significant difference in the use of chiropractic care between girls and boys. Non-Hispanic White children were more likely than non-Hispanic Black or Hispanic children to have seen a chiropractor.

Is spinal manipulation safe?

A 2017 review brought together evidence from 250 scientific publications related to risks and side effects of spinal manipulation or mobilization and reached the following conclusions:

Transient mild-to-moderate side effects—most commonly, increased pain or discomfort, stiffness, or headache—often occur after spinal manipulation or mobilization. Most of these side effects go away within 24 hours.

Serious side effects, such as serious spinal or neurological problems or strokes involving arteries in the neck, have been reported. However, they are very rare, and there are no accurate estimates of how often they occur.

The likelihood of a serious side effect may be greater in people who have underlying health problems that increase their risk of injury.

Because preexisting health problems may increase the risks associated with spinal manipulation or mobilization, it is important for practitioners to assess patients thoroughly and for patients to share information about their health conditions and medications with the practitioner.

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