We get asked all the time if spinal manipulation is safer and/or effective for the neck or back. We definitely believe that it is, or we wouldn't perform this activity. This blog post explores the safety and effectiveness of spinal manipulation (back cracking, chiropractic adjustment, etc.)
What is Spinal Manipulation?
This section is going to get somewhat technical, and we apologize for that.
Spinal Manipulation is the result of a High Velocity Low Amplitude Thrust (HVLAT). That means it is a fast motion through a short distance. It is the typical "adjustment" or "back cracking" that you have either heard about or experienced. This may be the first place that you hear this:
Spinal manipulation does not move are readjust your spine!
Many studies have confirmed that all that happens is what is termed a cavitation. A cavitation is a popping sensation similar to what you feel when you crack your knuckles. (here, here, here , here) So adjustment is a misnomer, nothing i being adjusted or moved.
What is happening is termed a neurophysiological effect (that is a big word and is hard to pronounce). This effect includes changes to nociception (pain perception), stimulation of the spinal reflex (alters muscle activity thereby relieving spasm), stimulation of pain centers in the brain, patients belief it will work, and placebo effects. All of these things have been shown to happen as a result of a spinal manipulation (source). These are all good things. They can make you feel better, give you more movement, and help you relax. Once the manipulation is done you can re-educate your body to move easier into some of the previously restricted positions!
If your back doesn't adjust, what is the noise you are hearing? This noise is called cavitation. That's a big word to say and is difficult to pronounce. Cavitation is happening in any joint when you crack it. When you crack your knuckles in your hands, you are cavitating them or getting a cavitation. A cavitation is the popping of gas bubbles in the joints. So for the spine specifically it is popping of gas bubbles in the facet joints.
Is Spinal Manipulation Safe?
The quick and simple answer is "YES!" Spinal manipulation is amazingly safe, and is super effective. Study after study have come out that say the following:
Risk of worsening low back disc herniation = 1 in 3.7 million manipulations
Complications = 1 in 100 million manipulations
37,000 - 148,000 times safer than using NSAIDs (Non-Steroidal Anti-Inflammatory Drugs; like Ibuprofen or Naproxen). Complications in NSAID use varies from 1 to 4 in every 100 uses
55,500 - 444,000 times safer than surgery (surgical complications range from 1.5 to 12 issues per 100 surgeries)
Adverse event for neck and upper back is 1 in 2.067 million manipulations
We didn't put this in the list, but you are 10x more likely to have a catastrophic event running a marathon than having spinal manipulation. (here, here, here, here)
We would be remiss if we didn't point out that a thorough medical history needs to be taken in order to ensure the safety of the spinal manipulation. The lumbar spine is more robust than the cervical spine, but there are still things to screen out. In the lumbar spine a good history will screen out symptoms of Cauda Equina Syndrome, Cancer, Fracture, and infection. In the upper back and neck, we want to eliminate any chance that you have a vascular issue in the blood supply to the brain before we do a manipulation, make sure that there is no ligament laxity that will cause issues to the spinal cord, and make sure the cranial nerves are working properly.
The biggest reason for an adverse event is a poor history and examination!
So now that we know spinal manipulation is safe, why should we do it? Sitting in a chair at my house is "safe." Does it do anything? Does it help you feel better?
Is Spinal Manipulation Effective?
The short answer is yes (I probably wouldn't be writing this if it was no). The real question may be, if it is not "adjusting" my spine or putting my spine back into position, how is it effective?
Because there has been so much research on spinal manipulation, we know it is effective and who it is effective for.
In the cervical spine (neck) there is some evidence for it's effectiveness in treating a myriad of symptoms. Practice guidelines show strong evidence for cervical mobilization, manipulation , strengthening, exercises, education, nerve mobilization, and traction types of treatment (here). There has been studies that show that people get better faster when using thrust manipulation to the cervical spine (here, here).
In the low back, the evidence is strong for manipulation. Manipulation has shown to decrease pain in people that have disc issues. The Clinical Practice Guidelines (CPG) show that many people benefit from thrust manipulation with exercises as opposed to just thrust manipulation alone (here).
A strong variable in using spinal manipulation remains. If you, the client, believe that it will help, it will help. If you don't think it will help, then it won't help.
Some Important Things to Note
This article is meant to inform you, the reader, about how safe and effective spinal manipulation can be. At BodyFix PT and Performance, we are uniquely qualified to deliver this treatment. This type of treatment is not just performed on you. After a thorough examination we will discuss with you the best options for getting you better faster. If spinal manipulation is part of that, great. If spinal manipulation is not part of that, great. We emphasize the individual and not all people need or want spinal manipulation.
If you found this article helpful, please share it with your friends and family that may also find it beneficial.
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