Spinal Manipulation in Physical Therapy

Spinal manipulation is a "hands-on" treatment method that should be done by a skilled professional. It involves moving a spinal joint beyond its active limit of motion but within its anatomical limits. It is a localized, high-speed, controlled thrust¹ which may cause an audible click or a "popping" sensation that is usually painless.

Under the Health Professions Act, spinal manipulation is a restricted activity. This means only health professionals with the necessary competence may perform spinal manipulation. Physical therapists (PTs) who use spinal manipulation as part of treatment are registered with the College of Physical Therapists of British Columbia.

Spinal manipulation may be applied to any spinal joints, from the top of the neck to the low back (i.e. the cervical, thoracic, and lumbar areas of the back). Technically speaking, manipulation to sacro-iliac and rib joints is also “spinal” manipulation, because the sacro-iliac and rib joints attach to the spine.

PTs use spinal manipulation to treat certain problems that affect joints, nerves, ligaments, and muscles. The goal of spinal manipulation is to reduce pain and restore movement and function to joints. Many find it effective in reducing pain that comes from the spine, sacro-iliac, and rib joints. Improved motion and function in these joints may have indirect beneficial effects on other areas of the body.

Risk is associated with any effective health care treatment and spinal manipulation is no exception. Mild temporary side effects often occur. These include, but are not limited to: local discomfort, numbness, dizziness, and/or headache. Serious side effects are much less frequent, but they can occur. These include, but are not limited to: nerve injury, fracture, and, rarely, with neck manipulation, stroke and death. Estimates of the risk of serious side effects from a neck manipulation vary widely, but the risk appears “smaller than that associated with many commonly used diagnostic tests or prescription drugs.”² Your PT will determine whether you are a suitable candidate for spinal manipulation. This decision will be guided by the results of your physical examination and knowledge of your relevant health history, including drugs, medications, and any surgery you have had.

If your PT determines you could benefit from spinal manipulation, he or she will discuss the proposed care plan with you to help you make an informed or educated decision about whether to proceed.

Before you consent to receiving spinal manipulation, it is important that you understand its potential benefits and risks. Discuss these with your PT. Ask questions and discuss any concerns you might have about spinal manipulation. It is important for you to make a voluntary decision. You do not have to make up your mind right away — some people prefer to "sleep on it" for a night or two. If you choose to receive spinal manipulation, you may be asked to sign a form to show your consent to this treatment. It is also important to know that your consent can be withdrawn at any time.

No. For some, spinal manipulation may not be an appropriate treatment option. Those with malignant and inflammatory diseases, suspected fractures, osteoporosis, disordered mental states, and those who use or have used certain drugs/medications such as steroids and anti-clotting agents (anticoagulants) generally are not suitable candidates for spinal manipulation.

Spinal manipulation is one of many skilled techniques PTs use to treat a variety of conditions. As a professional with expertise in a variety of treatment methods, your PT can provide advice about treatment options for those who are not suitable candidates or do not wish to have spinal manipulation.

Effective physical therapy is based on good communication between you and your PT. Keep your PT informed about any changes in the way you feel during and after spinal manipulation. This feedback will help assure that you receive the right treatment at the right time. If you are uncomfortable at any time during treatment, discuss it with your PT. That way, treatment may be tailored to your comfort level. Physical therapy is client-centred, which means your wishes are respected and treatment is adjusted accordingly.