What Does the Research Say About Spinal Manipulation for Back and Neck Pain?

Quick answer: The National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, says spinal manipulation may lead to small improvements in low-back pain and function, and can be helpful for acute neck pain, although the reviewers of that neck evidence said to interpret it with caution. Mild-to-moderate side effects often occur and most go away within 24 hours. Serious side effects are very rare, and there are no accurate estimates of how often they occur. We’re a chiropractic office, and we’d rather you read what it really says than take our word for it.

What is spinal manipulation?

NCCIH describes it as a technique where practitioners use their hands or a device to apply a controlled thrust to a joint of your spine. It says most spinal manipulations are done by chiropractors, although other licensed professionals, including osteopathic physicians and physical therapists, also use the technique.

What does the evidence say for low-back pain?

NCCIH says spinal manipulation is one of several nondrug approaches that may be used to treat acute and chronic low-back pain, and that it “may lead to small improvements in both pain and function.” Function means how low-back pain affects parts of your life such as walking, standing, sleeping and doing household tasks.

Small isn’t a word we’d normally pick for our own website. We’re including it because it’s what the source says.

Here are the main findings NCCIH reports:

Condition	Evidence NCCIH cites	What it found	The caveat
Acute low-back pain (no more than 6 weeks)	2017 analysis, 15 studies, 1,699 participants, and 12 studies, 1,381 participants on function	Modest improvement in pain, similar to nonsteroidal anti-inflammatory drugs, and in function	Moderate rather than high quality, because it was not completely consistent
Chronic low-back pain	2019 review, 47 studies, 9,211 participants	Short-term pain relief similar to other recommended therapies; slightly better for function	Moderate-quality evidence
Chronic low-back pain	2020 Agency for Healthcare Research and Quality analysis, 8 studies, 2,580 participants	Small improvements in function, and in pain in the intermediate term	Strength of evidence low for function, moderate for pain
Acute neck pain (less than 6 weeks)	2021 analysis, 6 studies, 446 participants	Helpful in reducing pain intensity	Interpret with caution: a small amount of evidence and varied study designs
Chronic neck pain (12 weeks or longer)	2019 review, 47 trials, 4,460 participants	May reduce pain and improve function	Low-to-moderate quality: most studies were small and results inconsistent

NCCIH also notes that the American College of Physicians’ 2017 guidelines list spinal manipulation as one of several options that may help people with acute or chronic low-back pain, although the strength of the evidence favoring it is low. NIAMS, a separate NIH institute, lists manipulation of the spine and nearby tissues among complementary treatments that may help relieve pain.

What does the evidence say for neck pain?

NCCIH says “spinal manipulation can be helpful for acute neck pain, and manipulation or mobilization can be helpful for chronic neck pain.” The table above gives the numbers and the limits. If your neck pain follows a crash, read whiplash and neck pain after a crash as well, because that NCCIH evidence covers neck pain in general and doesn’t single out whiplash.

What are the side effects?

NCCIH cites a 2017 review of evidence from 250 scientific publications, which reached these conclusions:

• Mild-to-moderate side effects often occur. Most commonly increased pain or discomfort, stiffness or headache. Most of these go away within 24 hours.
• Serious side effects have been reported, but are very rare. These include serious spinal or neurological problems or strokes involving arteries in the neck. There are no accurate estimates of how often they occur.
• Risk may be greater for some people. The likelihood of a serious side effect may be greater in people who have underlying health problems that increase their risk of injury.

What about strokes and artery tears?

Patients should know about this one. NCCIH says a type of spinal manipulation that focuses on the neck has been linked to small, potentially dangerous tears in the artery walls in the neck. These tears are rare but can lead to a stroke. It also says any kind of sudden neck movement, such as those involved in playing sports, getting whiplash, and violent vomiting or coughing, may also increase the risk of tears.

NCCIH says the available evidence suggests the incidence in people getting spinal manipulation is low, and there is disagreement about whether manipulation can actually cause these tears. Patients still need to be informed. If you have questions about it, ask before anyone adjusts your neck, including us.

What should I ask before seeing a chiropractor?

NCCIH suggests these steps, and we agree with them:

• Ask about the chiropractor’s education and licensure. Dr. Ron Spallone holds Colorado chiropractic license 4179.
• Tell the chiropractor about your health history, including medical conditions.
• Ask if the chiropractor has specialized training or experience treating your condition.
• Tell the chiropractor about any medications, prescription or over-the-counter, and any dietary supplements you take.
• If you are pregnant, discuss the potential risks and benefits with your health care provider.

How does this fit with how we work?

Evidence for groups of people can’t tell you what will happen with your back. That’s why a visit here starts with a conversation and an assessment. “Dr. Spallone did a very thorough assessment and came up with a comprehensive plan with alternatives,” wrote Matthew Enright in a Google review. One patient’s experience isn’t a promise, but it shows how the office tries to work.

If you’d like to talk it through, read about chiropractic care at our clinic and when to get back pain checked after a wreck. If you were hurt in a crash, start with car accident and whiplash care, and check how medical payments coverage works in Colorado. You can read about Dr. Spallone or call (303) 980-5699 or contact the office.