According to the National Institutes of Health National Center for Complementary and Integrative Health (NCCIH), spinal adjustment or manipulation is usually done by a chiropractor. It is done by hand or by a device to place a sudden thrust on a joint of the spine, causing it to move more than it would naturally. Chiropractic medical providers believe this manipulation can improve function and movement of the spine.
NCCIH says that about 9 to 10 percent of Americans use chiropractic care every year for relief of back or neck pain, headache, general wellness, disease prevention, energy, strengthening the immune system, and improving memory and concentration. Spinal manipulation of the neck or back is used mainly to treat low back pain, neck pain, and headache.
It is normal to have some increase in pain after spinal manipulation. According to the Mayo Clinic, side effects of spinal manipulation can include increased pain, fatigue, and headache. These side effects should not be severe or long-lasting. Although the risks from spinal manipulation by a trained and licensed chiropractor are low, complications can include damage to the disc between spine joints (herniated disc) or damage to nerves leaving the spinal column. These complications may cause longer-lasting pain, numbness, tingling, or weakness.
A very rare but very serious cause of pain and weakness after neck manipulation is a tear in one of the arteries that pass through the spine of the neck to supply the brain. A tear in one or more of these arteries can cause a stroke. This injury is called a cervical artery dissection. It may also be caused by a sports or whiplash injury that suddenly and forcefully moves the neck. The symptoms are sudden pain and loss of movement.
Should You Get Spinal Manipulation?
According to NCCIH, there is moderate evidence in studies to support spinal manipulation for low back pain and weak evidence for headache or neck pain. A review of 15 studies on spinal manipulation for low back pain, involving about 1,700 patients, found that spinal manipulation can give moderate relief to people with low back pain.
A review of 51 trials on spinal manipulation for neck pain, involving over 2,900 patients found that evidence for relief for neck pain was weak. A review of studies on spinal manipulation for headache rated the evidence of improvement to be low.
According to a 2020 review of alternative therapies for pain, published in the journal Advances in Therapy, there is a lack of evidence to support the use of spinal manipulation for migraine headaches, although over 50 percent of chiropractors use this treatment for migraines. This review also found that evidence for relief of neck pain was weak and that spinal manipulation was a poor choice compared to other therapies.
NCCIH says spinal manipulation has been studied for many other conditions including fibromyalgia, pediatric ear infections, COPD, bedwetting, menstrual pain, asthma, and high blood pressure without evidence of relief or improvement in these conditions.
Recommendation for Spinal Manipulation
The best evidence for the use of spinal manipulation is for low back pain. Clinical practice guidelines from the American College of Physicians recommend spinal manipulation as one of the options for treating low back pain.
NCCIH says this treatment is relatively safe when performed by a trained chiropractor, physical therapist, or osteopathic physician. The most common side effect is temporary pain and stiffness. If you see a chiropractor for back pain, you should tell your chiropractor about any medical conditions you have and any dietary supplements you take. Mayo Clinic advises against spinal manipulation if you have
- Severe osteoporosis
- Back or neck pain that includes tingling, numbness, or weakness
- Cancer in your spine
- A diagnoses of any type of spinal abnormality
- An increased risk of stroke
According to the CDC, common stroke risks include a previous stroke or transient ischemic attack, high blood pressure, high cholesterol, heart disease, diabetes, and obesity. Mayo Clin notes that spinal manipulation does not work for everyone, so if you do not see any improvement after several weeks, it might not be the best option for you.