DEAR MAYO CLINIC: What happens during a spinal adjustment? Can professionals other than chiropractors safely do spinal adjustments?
ANSWER: Chiropractors commonly perform spinal adjustments, also known as spinal manipulation. However, osteopathic doctors, physical therapists and medical doctors who are specially trained in manipulation may provide the service as well. The purposes of spinal manipulation are to alleviate pain and to optimize spinal motion in regions that are notably stiff or tight.
Specific techniques may differ among practitioners. In general, during spinal manipulation, the practitioner applies a controlled amount of force to a spinal joint in the neck or back, either manually or using a device. Sometimes the force terminates in a quick, shallow thrust to the targeted joint. Alternatively, a rhythmic, nonthrust force also can be applied to improve joint motion in your spine and pelvis. The practitioner also may use a special table to help perform spinal adjustments more effectively.
Practitioners who perform spinal manipulation also may perform a massage-type technique called soft tissue mobilization, either immediately before or just following spinal manipulation. Like spinal manipulation, soft tissue mobilization also can be performed by specially trained chiropractors, osteopathic doctors, physical therapists and medical doctors.
Several types of soft tissue mobilization exist, but one of the more common approaches is called myofascial release. Like massage, this approach is typically performed on the skin. It combines slow, low-pressure glides over the affected muscles and connective tissues with higher-pressure holds as your body is slowly guided through specific movements. Like spinal manipulation, the purposes of soft tissue mobilization are to alleviate pain and to optimize movement, as well as to release tension in tight muscles affecting your spine.
Available evidence indicates that spinal manipulation can help with low back pain, especially if the pain is recent and not due to compression of a nerve root. For some people with low back pain, spinal manipulation may be just as effective as conventional care, such as exercise and pain relief medications. There's also some evidence that spinal manipulation may help common headaches and neck pain.
Spinal manipulation is generally considered to be safe when it's performed by a trained and licensed practitioner. Common side effects are soreness in the treated area, dizziness or tiredness. These problems typically clear up within one to two days. Serious side effects are rare but may include pinching of spinal nerves, resulting in leg pain and weakness, or worsening of a herniated disk. Thrust manipulation to the neck has rarely been associated with stroke.
Spinal manipulation generally isn't recommended if you have severe osteoporosis, cancer in your spine, previous spinal surgery or inflammatory arthritis.
In situations where spinal manipulation is considered unsafe, your healthcare professional may recommend alternative options, depending on the cause of your neck or back pain.
These may include one or a combination of the following: specific home exercises and stretches for your spine, massage therapy, yoga, tai chi, acupuncture, cognitive behavioral therapy, mindfulness-based stress reduction, oral medications, or spinal injections.
If you're considering spinal manipulation therapy, ask your healthcare professional for a referral. Importantly, let the practitioner doing the spinal manipulation know about any other conditions you may have and other treatments you may be receiving. — Dr. Benjamin Holmes, and Dr. Ralph Gay, Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota