Why Spinal Manipulation Isn’t “Realigning” Your Spine.

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.

Spinal manipulation is often described as a way to “realign” the spine or “put joints back into place”. This language is still used in some areas of manual therapy - particularly Chiropractic - but modern research shows that this is not what’s really happening.

As an Osteopath, spinal manipulation is used as part of a broader approach to support pain relief, mobility, and function - manipulation is only one of an Osteopath’s tools in their toolkit!

It is important to understand what manipulation does, and just as importantly, what it does not do, when to do it…. and when not to do it.

Where the Idea of Realignment Comes From

Historically, spinal manipulation was thought to correct misalignments or “subluxations” in the spine. These ideas date back to the late 19th century, long before imaging and biomechanics research developed our modern understanding of how the spine functions.

Today, we know that the spine does not slip in and out of place in the way those early theories suggested. The joints of the spine are supported by strong ligaments, discs, and muscles that make such misalignments impossible without serious trauma (Bogduk, 2016).

What Actually Happens During a Manipulation

When you hear or feel a “click” during a spinal manipulation, it is not the sound of bones being realigned. It is a small release of gas from the fluid within a joint, known as cavitation (Unsworth et al., 1971).

The short-term improvements people feel after manipulation are thought to come from neurophysiological changes - in simple terms, how the brain and nervous system interpret stimulus, pain and movement. Research shows that manipulation can:

• Reduce pain sensitivity in the nervous system (Bialosky et al., 2009)

• Improve muscle tone and local movement temporarily

• Enhance the feeling of mobility and confidence in movement

Why Understanding Matters

Believing that the spine is “out of place” can create unnecessary fear and dependence on repeated treatments… and can make it very expensive with often short-lived results. Education helps you to feel empowered rather than fragile. Spinal manipulation can be a useful tool, but it should be viewed as a way to influence the body, not fix it.

The best outcomes occur when manipulation is combined with exercise, movement retraining, and self-management strategies - helping you build strength, confidence, and control (Paige et al., 2017; Qaseem et al., 2017). However, fantastic outcomes can happen without manipulation too.

A Modern, Evidence-Based Perspective

Modern Osteopathic and Physiotherapy practice recognises that no single technique “corrects” posture or realigns bones. Instead, the focus is on improving how the body functions as a whole - reducing pain, restoring movement, and supporting long-term health and wellbeing.

When you visit the clinic you can expect our clinicians to combine manual therapy with active rehabilitation and education so that treatment is meaningful, collaborative, and sustainable.

Conclusion

Spinal manipulation is not about realigning the spine — it is about helping the body move and feel better. When used appropriately, it can reduce pain and improve mobility, but the real progress comes from what you do next: strengthening, moving, and regaining confidence in your body.

References

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

• Bogduk N. (2016). Clinical Anatomy of the Lumbar Spine and Sacrum. 5th ed. Churchill Livingstone.

• 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.