Is Spinal Manipulation Right For You?

Low Back Pain and How To Improve Lumbar Mobility

Spinal Manipulation

Every once in awhile, I love the sweet relief of feeling my back crack, don’t you? That instantaneous release of pressure and audible sound makes us feel like something good just happened. But, when you’re having low back pain, how do you know if spinal manipulation is right for you? With so many possible causes of your low back pain and so many treatment options, will getting your spine manipulated really make things better? Is it safe?

Let’s take a look at spinal manipulation and how to identify if it’s right for you…

If you’ve ever been to a chiropractor, you may be somewhat familiar with spinal manipulation, as this is a mainstay in many of their treatment approaches for back pain.

Physical Therapists can also perform spinal manipulation, although we only perform these techniques on a particular subset of patients with low back pain – those classified with mobility deficits.

Low Back Pain With Mobility Deficits

If you have low back pain, mobility deficits might present with:

  • Low back, buttock, or thigh pain
  • Pain on one side only
  • Likely an awkward movement brought on your pain
  • Reduced lumbar range of motion
  • Stiffness in one or more segments of your spine
  • Pain reproduced by your therapist pushing on the involved spine segments
  • Pelvic girdle or hip mobility limitations

What Is Spinal Manipulation?

Spinal manipulation is a quick thrust mobilization technique of one or more joints. It is used mainly to reduce spinal pain and increase range of motion.

What actually happens when the spine is manipulated?

Well, we know some, but we don’t know all of what happens during spinal manipulation and why it often results in relief.

We do know that the technique results in stretching of joint capsules1.

We also know that spinal manipulation has a direct effect on the central nervous system2,3,4,5,6,7, even stimulating pain centers in the brain8.

It’s also hard to ignore the placebo effect this treatment can have…

For example: I know that when I hear a “pop” I feel better than when I don’t. However, the evidence suggests that the actual cavitation, or “pop”, makes no difference in improvement9.

Is Spinal Manipulation Safe?

Serious complications of spinal manipulation are rare10,11,12, especially when it comes to the lumbar spine. Estimates of the incidence of serious adverse events from published case reports and case series are about 1 adverse event per 1 to 2 million treatments13,14. To put this in perspective, you have a 100-400 times greater risk of serious complications by taking NSAIDs (anti-inflammatories)15.

With that said, here are the contraindications to spinal manipulation16:

  • Bone weakening (osteoporosis)
  • Nuerological:
    • Cord compression
    • Cauda equina compression
    • Nerve root compression with increasing neurological deficit
  • Vascular:
    • Aortic aneurysm
    • Bleeding into joints
  • Lack of diagnosis
  • Patient positioning can’t be achieved because of pain or resistance

Who Might Benefit From Spinal Manipulation for Low Back Pain?

Based on validated research, a Clinical Prediction Rule can predict the likelihood of you having a successful outcome from spinal manipulation. If 4 or more of these predictors are present, your probability of success with manipulation increases from 45% to 95%17:

  • Duration of symptoms less than 16 days
  • No symptoms felt lower than the knee
  • Limited mobility in the lumbar spine
  • At least one hip has good mobility
    • At least 35 degrees of internal rotation
  • Low levels of fear

To simplify things, if these 2 predictors are present, your probability of success with manipulation has a moderate to large shift18:

  • Duration of symptoms less than 16 days
  • Not having symptoms distal to the knee

In the research, the participants who met these criteria had greater reductions in disability after receiving manipulation than the ones who received trunk strengthening only19,20,21.

Now, this isn’t to say that you can’t benefit from manipulation if you don’t meet these criteria…

However, it is good to keep in mind that spinal manipulation has been found to be no better than other therapies for patients with chronic or longstanding low back pain22.

Also, it’s good to keep in mind that, despite its popularity, recent systematic reviews have shown only marginal outcomes from spinal manipulation across groups of patients with low back pain23,24.

My best advice: if you and your Physical Therapist decide that spinal manipulation is right for you, it would be best to include it as part of a comprehensive treatment plan25 with emphasis on improving strength and mobility deficits and encouragement to pursue an active lifestyle.”

Exercises For Improving Lumbar Mobility

Spinal manipulation may be beneficial for reducing pain and disability, but if you continue to lack mobility in your lumbar and thoracic spine, there are other mobilization exercises you can perform. Here are a couple simple ones I’d recommend:

  1. Lumbar Rotations in Hooklying


2. Quadruped Rock Back

Question: What have you found to be most beneficial for improving Lumbar mobility?

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  2. Pickar JG, Wheeler JD. Response of muscle proprioceptors to spinal manipulative-like loads in the anesthetized cat. J Manipulative Physiol Ther. 2001;24:2-11. ↩︎
  3. Indahl A, et al. Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine. 1997;22:2834-2840. ↩︎
  4. George SZ, et al. Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study. BMC Musculoskeletal Disord. 2006;7-68. ↩︎
  5. Vicenzino B, Collins D, Wright A. The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia. Pain. 1996;68:69-74. ↩︎
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  15. Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther. 1995;18:530-536. ↩︎
  16. Gibbons P, Tehan P. Patient positioning and spinal locking for lumbar spine rotation manipulation. Manual Therapy. 2001;6:3:130-138. ↩︎
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