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

Quick answer: According to the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, spinal manipulation may lead to small improvements in low-back pain and function, and can be helpful for acute neck pain, though the reviewers said to read those neck results with caution. Mild side effects often occur and most go away within 24 hours. Serious ones have been reported and are very rare. Dr. Luke Audirsch would rather you read this before your first visit in Cabot than after 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 the spine. The amount of force can vary, but the thrust moves the joint more than it would on its own. Spinal mobilization is different: it doesn’t involve a thrust, it stays within a joint’s natural range of motion, and the patient can control it.

Most spinal manipulations are done by chiropractors. According to survey data NCCIH cites, 11.0 percent of U.S. adults received chiropractic care in the past year as of 2022, up from 7.4 percent in 2002.

What did the studies find?

These are the summaries on the NCCIH page, which was last updated in September 2022:

Condition	What was found	The caveat
Acute low-back pain (no more than 6 weeks)	A 2017 analysis of 15 studies (1,699 participants) linked it to a modest improvement in pain, similar to nonsteroidal anti-inflammatory drugs	Moderate-quality evidence, not completely consistent
Chronic low-back pain	A 2019 review of 47 studies (9,211 participants) found short-term pain relief similar to other recommended therapies, and function slightly better	Moderate-quality evidence, not completely consistent
Acute neck pain (less than 6 weeks)	A 2021 analysis of 6 studies (446 participants) found it helpful in reducing pain intensity	Interpret with caution: little evidence and varied study designs
Chronic neck pain (12 weeks or longer)	A 2019 review of 47 trials (4,460 participants) concluded manipulation or mobilization may reduce pain and improve function	Low-to-moderate quality: most studies were small and inconsistent
Headache from the neck (cervicogenic)	A 2020 review of 7 studies (601 participants) found it may reduce frequency and intensity	No quality rating is given here, and a separate migraine review was called preliminary
Sciatica	Not widely used, but a 2015 review found it may help	The authors noted many limitations

What does “small improvements” mean for me?

It means honest expectations. In a 2020 federal analysis, spinal manipulation for low-back pain was linked to small improvements in function in the short and intermediate term, and small improvements in pain in the intermediate term. Those are averages across groups of people. They can’t tell you how your own back will respond.

Spinal manipulation is one option among several. In its 2017 guidelines, the American College of Physicians said it is one of several options that may help with acute or chronic low-back pain, although the strength of the evidence is low.

What doesn’t the research show?

Three limits are worth knowing:

• Other conditions. A 2021 review found only 6 studies of high or acceptable quality on conditions that aren’t musculoskeletal, such as high blood pressure or menstrual cramps. None showed a clear benefit.
• Specific techniques. The NCCIH page covers manipulation broadly. It doesn’t break out the low-force, prone specific technique Dr. Luke uses.
• Car wrecks. The page covers back and neck pain in general, and it doesn’t separately report results for whiplash after a crash or back pain after a wreck.

Is spinal manipulation safe?

NCCIH reports these conclusions from a 2017 review of 250 publications:

• Temporary mild-to-moderate side effects, most commonly increased pain or discomfort, stiffness or headache, often occur. Most go away within 24 hours.
• Serious side effects, such as serious spinal or neurological problems or strokes involving arteries in the neck, have been reported. They are very rare, and there are no accurate estimates of how often they occur.
• The likelihood of a serious side effect may be greater in people with underlying health problems that increase their risk of injury.

Neck manipulation has also been linked to small tears in the artery walls of the neck, called cervical artery dissections, which are rare but can lead to a stroke. Any sudden neck movement, such as playing sports or getting whiplash, may also increase the risk. NCCIH says the incidence in people getting spinal manipulation appears low, and that there is disagreement about whether manipulation can actually cause these tears. It also says patients need to be informed of this potential risk.

If you are pregnant, NCCIH says reports of serious problems are very rare, but there hasn’t been much rigorous research, so discuss the risks and benefits with your provider.

What should I tell the chiropractor?

NCCIH says practitioners should assess patients thoroughly, and patients should share their health conditions and medications. Before Dr. Luke adjusts you, tell him about:

• any health conditions and medications
• past surgeries, fractures or spine problems
• a recent head or neck injury, including a car wreck
• whether you are pregnant
• anything that felt wrong after a past adjustment

How does this shape care at our office?

Your first visit is a private conversation and a thorough exam, with X-rays if your case calls for them, because X-rays help show whether it is safe to perform an adjustment. At your report of findings, Dr. Luke explains what he found, what he recommends and how long it may take, and you can ask about any of this.

“He explained your bones can be moved without that bone crack sound,” wrote Carol Northcutt in a Google review. “I appreciated how gentle the prone adjustment was,” wrote Emilee Turner.

Why see Dr. Luke for back or neck pain in Cabot?

You will get a clear explanation and a plan you can question, along with chiropractic adjustments using a low-force, prone specific technique. Same-day appointments are offered. Get hours and directions for the Cabot office, then call or text (501) 605-6660 or contact the office.