What Spinal Manipulation Can and Can't Do for Neck and Low-Back Pain

Quick answer: Spinal manipulation may lead to small improvements in low-back pain and function, and it can be helpful for acute neck pain. That is the summary from the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health.

Mild, short-lived side effects such as increased pain or stiffness are common. If you are weighing chiropractic care in Midtown Manhattan, here is what the research summary says, without the hype.

This article is general information, not a diagnosis.

What is spinal manipulation?

NCCIH describes spinal manipulation as a technique where practitioners use their hands or a device to apply a controlled thrust to a joint of the spine. The thrust moves the joint more than it would on its own.

It is different from spinal mobilization, which has no thrust, stays within the joint’s natural range of motion and can be controlled by the patient.

NCCIH says most spinal manipulations are done by chiropractors, and that chiropractic treatment often involves it.

What does the research say about low-back pain?

NCCIH says spinal manipulation is one of several nondrug approaches that may be used for acute and chronic low-back pain. It may lead to small improvements in both pain and function.

“Function” means how back pain affects daily life: walking, standing, sleeping and household tasks.

For acute low-back pain, NCCIH cites a 2017 analysis that found a modest improvement in pain, similar to the benefit of nonsteroidal anti-inflammatory drugs. The evidence was rated moderate quality.

What does the research say about neck pain?

NCCIH says spinal manipulation can be helpful for acute neck pain, and manipulation or mobilization can be helpful for chronic neck pain.

It adds a caution: for acute neck pain, the results should be interpreted carefully because the amount of evidence is small and the studies varied.

How strong is the evidence?

Condition	What NCCIH reports	Evidence quality NCCIH gives
Acute low-back pain	Modest improvement in pain and in back function	Moderate
Chronic low-back pain	Short-term relief similar to other recommended therapies; function slightly better	Moderate
Acute neck pain	Helpful in reducing pain intensity	Small amount of evidence; interpret with caution
Chronic neck pain	May reduce pain and improve function	Low to moderate

Small and modest effects are still effects. They are also a reason to be wary of anyone promising a cure.

What side effects should you expect?

NCCIH says mild-to-moderate side effects often occur after spinal manipulation or mobilization. The most common are increased pain or discomfort, stiffness and headache. Most go away within 24 hours.

Serious side effects, such as serious spinal or neurological problems or strokes involving arteries in the neck, have been reported. NCCIH says they are very rare, and there are no accurate estimates of how often they happen.

What should you tell your chiropractor first?

NCCIH says the chance of a serious side effect may be greater in people with underlying health problems. It says practitioners should assess patients thoroughly, and patients should share their health conditions and medications.

Before your first visit, write down:

• Your health conditions and past injuries.
• Every medication you take.
• Whether you are pregnant. NCCIH says to discuss the risks and benefits with your health care provider first.
• When your pain started, and whether it followed a car accident or a work injury.

What about the neck and stroke risk?

NCCIH says a type of spinal manipulation that focuses on the neck has been linked to small, potentially dangerous tears in the artery walls of the neck, called cervical artery dissections. These tears are rare but can lead to a stroke.

It adds that any sudden neck movement, including whiplash, may also increase the risk of these tears. The available evidence suggests the incidence in people getting spinal manipulation is low, and there is disagreement about whether manipulation can actually cause them.

NCCIH’s point is simple: patients need to be told about this potential risk. Ask your chiropractor about it before neck manipulation.

Is spinal manipulation the only option?

No. NCCIH lists it as one of several nondrug approaches. Read what the same agency says about acupuncture for back and neck pain and massage therapy as part of recovery.

If your neck pain followed a crash, see whiplash and neck pain after a crash.

Why choose Nexus Spinal Care for chiropractic care in Midtown Manhattan?

Nexus Spinal Care offers chiropractic care at 211 East 43rd Street, Suite 741, in Midtown Manhattan. Visits are with Dr. Jean V. Laine, D.C., who earned his Doctor of Chiropractic from New York Chiropractic College in 2004 and speaks English, Creole, French and Spanish.

Dr. Laine examines you, hears your health history and explains the care he recommends.

Call (302) 590-8218 or see how to reach the office.