What is Spinal Manipulation? (“The Clicking” technique)

Spinal manipulation is a manual therapy technique used by Osteopaths, Physiotherapists, and Chiropractors to help relieve pain and improve movement. It is a commonly recognised forms of hands-on treatment for musculoskeletal problems, particularly those involving the back and neck.

However, what actually happens during a spinal manipulation – and how it works – is often misunderstood.

What Does a Spinal Manipulation Involve?

A spinal manipulation (sometimes called a high-velocity, low-amplitude thrust) is a quick, controlled movement applied to a joint, often producing an audible “click” or “pop” when leverage and pressure is applied to the area.

This sound is not bones “going back into place” nor is it your “spine being realigned - these are quite the outdated ideas. The sound is caused by gas being released from the joint fluid when pressure changes suddenly – a harmless and normal physical response known as cavitation (Unsworth et al., 1971).

How Does Spinal Manipulation Work?

Despite common myths, manipulation does not physically move vertebrae back into (or out of) alignment. Instead, research suggests it has its effects through a combination of:

• Neurophysiological mechanisms – changing how the nervous system processes pain (Bialosky et al., 2009).

• Muscle relaxation – reducing tension in the local surrounding soft tissues.

• Improved joint movement – helping stiff joints move more freely.

• Placebo and contextual effects – the touch, trust, and interaction between patient and practitioner can enhance outcomes (Rossettini et al., 2018).

The benefits are typically short-term, so manipulation is most effective when combined with active rehabilitation and exercise (Paige et al., 2017).

When Is Spinal Manipulation Used?

Spinal manipulation can be helpful for certain types of back pain, neck pain, and joint stiffness. Clinical guidelines support its use for short-term relief in non-specific low back pain, provided it is part of a broader management plan that includes movement/exercise and self-management strategies (Qaseem et al., 2017).

It is not appropriate for everyone – a qualified practitioner will assess whether it is safe and suitable before using this technique. Nor is it everyone’s preference for treatment - don’t forget this is only one of the tools in an Osteopath’s toolkit!

To conclude, spinal manipulation is a skilled manual therapy technique that can help reduce pain and improve mobility in the short term. However, it should be viewed as one part of a comprehensive treatment plan – not a standalone “fix”. The best outcomes occur when manipulation is combined with exercise, education, and active movement strategies. However, the same outcome can be achieved without manipulation too.

References

• Bialosky JE, et al. (2009). Spinal manipulative therapy, mechanisms, and clinical application. Journal of Electromyography and Kinesiology, 19(5), 785–796.

• Paige NM, et al. (2017). Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain. JAMA, 317(14), 1451–1460.

• Qaseem A, et al. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530.

• Rossettini G, et al. (2018). The placebo effect in manual therapy: A systematic review. Musculoskeletal Science and Practice, 35, 88–97.

• Unsworth A, et al. (1971). Bubble formation in synovial fluid during joint manipulation. Annals of the Rheumatic Diseases, 30(4), 348–358.