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Is Spinal Manipulations And Adjustments Safe?

It's termed as "spinal manipulation" by spinal physiotherapists, and "spinal adjustments" by chiropractors and osteopaths, but they're essentially the same thing:

passive, high-velocity, low-amplitude thrust in a joint complex aimed to improve and/or restore motion, function and pain reduction.

The result of a successful manipulation or adjustment is a

  • "click"
  • "crack"
  • "pop"

sound and often with immediate pain/discomfort relief to the patient.

The popping and cracking experiences are mainly the sudden release of gases that are trapped in the fluid within the joint, and once that happens, the surface pressure of the joint capsule reduces immediately. Patients usually report also a sense of relief, decreased muscle pains.

how effective is a spinal adjustment or manipulation?

For simple cases of patients with purely acute spine pain with no neurological signs and no medical contraindications, spinal manipulation can be effective.

However, for patients whose spinal pain is one of the conditions (eg with other co-morbidities) or with neurological symptoms, it is not clear to proceed or the outcomes. Generally spinal adjustments or manipulations isn't for everyone.

what are the Contraindications and Precautions of spinal manipulations?

Spinal manipulations/adjustments are considered aggressive treatment techniques compared to other gentler techniques like

  • soft tissue management
  • joint mobilization
  • stretching
  • myofascial and trigger point release
  • etc

- hence the physiotherapist need to assess and be certain of the health and quality of the joint before performing any manipulations.

Contraindications include:

  • Spine fractures such as simple hairline cracks, spondylolisthesis or recent accident/injuries where fractures may not show up YET on X-rays

  • Upper cervical spine that is unstable, eg like if you look up you may feel your neck/head being not steady

  • Any conditions that may have caused the joint/ligaments to be weakened, such as cancer or arthritis

herniated disc

Generally spinal manipulations done by a spinal physiotherapist is safe and can be effective when done safely, properly and when the above conditions are met - it's very effective and quick to help patients with certain conditions eg wry neck ie when a patient wake up with their neck stuck in a specific painful position.

Manipulation in the hands of an experienced spinal physiotherapist will improve the range to near-full/normal almost immediately.

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