The Truth About Spinal Manipulation and Back Pain.
Spinal manipulation is one of the most commonly known treatment technique used by Osteopaths, Physiotherapists, and Chiropractors which could help manage back pain, neck pain, and spinal stiffness.
What Is Spinal Manipulation?
Spinal manipulation is a manual therapy technique that involves a quick, precise movement applied to a joint. It often produces an audible “click” or “pop”, which is simply a harmless release of gas from the joint fluid - not bones “going back into place” (Unsworth et al., 1971), and not “your spine realigning”.
Research shows that manipulation can have short-term benefits, especially for people with non-specific low back pain or neck stiffness (Paige et al., 2017). However, its effects are temporary and work best when combined with exercise, education, and active self-management (Qaseem et al., 2017).
When Spinal Manipulation Can Help
Manipulation can be an effective choice when:
Pain is related to stiffness or restricted joint movement
You need short-term pain relief to start moving again
The goal is to help calm sensitive tissues and improve mobility
It is part of a broader treatment plan that includes movement, strengthening, and education
It is a technique that you respond well to.
In these cases, spinal manipulation can help reduce pain sensitivity, relax muscles, and improve movement confidence (Bialosky et al., 2009).
Manipulation is not appropriate for everyone. It may not be suitable if you have:
Nerve-related symptoms such as numbness, tingling, or weakness
Osteoporosis, fractures, or inflammatory spinal conditions
Severe pain that limits movement or function
Underlying conditions affecting bone or joint integrity
Even when it is safe, manipulation alone is rarely enough to create lasting change. Evidence shows that the best outcomes come from combining manual therapy with rehabilitation exercises, massage, strength training, and education (Qaseem et al., 2017; Franke et al., 2015).
The Role of Massage and Exercise
Massage therapy can complement spinal manipulation by reducing muscle tension and improving circulation, while exercise helps restore strength, coordination, and resilience. Movement retraining, Clinical Pilates, and mobility work build long-term confidence and reduce recurrence of pain - something manipulation alone cannot achieve.
A Modern, Individual Approach
Our team of Osteopaths only use spinal manipulation when it’s clinically appropriate, when consent has been obtained i.e. you have consented to that as a treatment technique - not as a routine treatment. Every person’s pain is unique, so your plan should be too. For some, manipulation provides a helpful reset; for others, strength work or education is more effective.
Our goal is always the same: to help you understand your pain, move more freely, and stay active.
Conclusion
Spinal manipulation can be a useful tool for managing back and neck pain - but it’s not a cure-all. When used as part of a complete approach that includes exercise, massage, and lifestyle changes, it can support recovery and movement confidence.
Evidence continues to show that combining active and manual approaches produces the most meaningful, lasting results for spinal and musculoskeletal pain.
References
Bialosky JE, et al. (2009). Spinal manipulative therapy, mechanisms, and clinical application. Journal of Electromyography and Kinesiology, 19(5), 785–796.
Franke H, et al. (2015). Osteopathy for chronic low back pain: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 15, 286.
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.
Unsworth A, et al. (1971). Bubble formation in synovial fluid during joint manipulation. Annals of the Rheumatic Diseases, 30(4), 348–358.
