Nccih Logo

The COVID-19 outbreak is an emerging, rapidly evolving situation.

View public health information from CDC
View research information from NIH

Spinal Manipulation: What You Need To Know

spinal manipulation massage chiropractic_GettyImages

What is spinal manipulation?

  • Spinal manipulation is also called spinal manipulative therapy. It’s a technique where practitioners use their hands or a device to apply a controlled thrust (that is, a force of a specific magnitude or degree in a specific direction) 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 (and 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 do spinal manipulations.
  • Spinal manipulation is one of the most common complementary health approaches used by adults and children in the United States, the 2012 National Health Interview Survey (NHIS) showed.
  • For more information on what chiropractors do, see the National Center for Complementary and Integrative Health (NCCIH) webpage Chiropractic.

Why do people use spinal manipulation?

Among U.S. adults who used chiropractic or osteopathic manipulation, about 67 percent used it to treat a specific health condition, and 53 percent used it for wellness, the 2012 NHIS found. Specifically:

  • 43 percent used it for general wellness or disease prevention
  • 25 percent used it because it focuses on the whole person—their mind, body, and spirit
  • 16 percent used it for improved energy
  • 11 percent used it for better immune function
  • 5 percent used it to improve memory or concentration.

Previous research found that people report positive experiences and reduced pain as a result of receiving spinal manipulation, the NHIS authors noted.

Who uses spinal manipulation and has usage changed?

Between 2012 and 2017, U.S. adults’ use of chiropractic care (which usually involves spinal manipulation) during the past year increased slightly, from 9.1 percent to 10.3 percent, a comparison of NHIS data from the two years showed. The data also show that women were more likely than men to see a chiropractor, and that adults between the ages of 45 and 64 were more likely than people aged 18-44 or 65 and over to have visited 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 visit a chiropractor (12.7 percent) than Hispanic (6.6 percent) or non-Hispanic black (5.5 percent) adults.

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.

What are some of the pain conditions for which spinal manipulation has been used?

Is spinal manipulation safe?

Spinal manipulation is relatively safe when performed by a trained and licensed practitioner. The most common side effects of spinal manipulation are temporary muscle soreness, stiffness, or a temporary increase in pain.

Serious complications, deaths, and delays in diagnosis of serious illnesses have been associated with spinal manipulation, including in children, but are very rare.

NCCIH-Funded Research

NCCIH-supported studies have been investigating:

  • The clinical impact spinal manipulation/chiropractic may have on chronic low-back pain in U.S. veterans
  • How spinal manipulation compares with prescription drug therapy for long-term management of chronic low-back pain in older adults
  • How to optimize spinal manipulation treatment protocols for patients with low-back pain
  • Patients’ experiences and satisfaction with chiropractic care for chronic neck pain
  • How to best provide chiropractic care for veterans with musculoskeletal pain and mental health disorders.

More to Consider

  • In a 2017 clinical practice guideline, the ACP suggested that spinal manipulation remains a recommended treatment option for chronic low-back pain, saying that it is one of several options that show some evidence of effectiveness.
  • For information on finding a chiropractor, see the NCCIH webpage How To Find a Complementary Health Practitioner.
  • Before selecting a chiropractor:
    • Ask about the chiropractor’s education and licensure.
    • Tell the chiropractor about all of your medical conditions.
    • Ask if the chiropractor has specialized training or experience treating your condition.
    • Ask about how many sessions you’ll need and typical out-of-pocket costs and insurance coverage. (Medicare Part B covers manual manipulation of the spine if it is determined to be medically necessary.) For more information, see NCCIH’s fact sheet Paying for Complementary and Integrative Health Approaches.
    • Tell the chiropractor about any medications (prescription or over-the-counter) and dietary supplements you take. If the chiropractor suggests a dietary supplement, ask about potential interactions with your medications or other supplements.
  • Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

tty (for deaf and hard-of-hearing callers):

1-866-464-3615

Website: https://nccih.nih.gov/

Email: info@nccih.nih.gov (link sends e-mail)

PubMed®

A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.

Website: https://pubmed.ncbi.nlm.nih.gov/

National Institute of Neurological Disorders and Stroke (NINDS)

NINDS conducts and supports research on how the brain and nervous system function and on treatments for neurological diseases.

Toll-free in the U.S.: 1-800-352-9424

Website: https://www.ninds.nih.gov

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

The mission of NIAMS is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases.

Toll-free in the U.S.: 1-877-22-NIAMS

Website: https://www.niams.nih.gov

MedlinePlus

To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.

Website: https://www.medlineplus.gov/

NIH Clinical Research Trials and You

The National Institutes of Health (NIH) has created a website, NIH Clinical Research Trials and You, to help people learn about clinical trials, why they matter, and how to participate. The site includes questions and answers about clinical trials, guidance on how to find clinical trials through ClinicalTrials.gov and other resources, and stories about the personal experiences of clinical trial participants. Clinical trials are necessary to find better ways to prevent, diagnose, and treat diseases.

Website: https://www.nih.gov/health-information/nih-clinical-research-trials-you

Key References

Acknowledgments

NCCIH thanks Helene Langevin, M.D., David Shurtleff, Ph.D., Lanay Mudd, Ph.D., and Merav Sabri, Ph.D. NCCIH, for their review of the 2019 update of this publication. 

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

Last Updated: July 2019