What Research Says About Spinal Manipulation for Back and Neck Pain

Quick answer: The National Center for Complementary and Integrative Health, part of the National Institutes of Health, says spinal manipulation may lead to small improvements in pain and function for low-back pain, and can be helpful for acute neck pain. Mild-to-moderate side effects often occur, and most go away within 24 hours. Serious side effects are very rare. If you are thinking about an adjustment in Decatur after a car accident, that is the honest picture: modest benefit, some short-lived soreness and a real need for a thorough exam first.

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. The amount of force can vary, but the thrust moves the joint more than it would on its own. Mobilization is different: it does not involve a thrust, stays within a joint’s natural range of motion and can be controlled by the patient.

Most spinal manipulations are done by chiropractors, although osteopathic physicians and physical therapists use the technique too. In 2022, 11.0 percent of U.S. adults received chiropractic care during the past year, compared to 7.4 percent in 2002, according to national survey data.

What do the studies show?

Here is what the page reports, by condition:

Condition	What was reviewed	What it found	How solid
Acute low-back pain, up to 6 weeks	2017 analysis, 15 studies, 1,699 people for pain; 12 studies, 1,381 people for function	Modest improvement in pain, similar to nonsteroidal anti-inflammatory drugs, and in back function	Moderate quality
Chronic low-back pain	2019 review, 47 studies, 9,211 people	Short-term pain relief similar to other recommended therapies; function slightly better	Moderate quality
Chronic low-back pain	2020 federal analysis, 8 studies, 2,580 people	Small improvements in function and pain	Low for function, moderate for pain
Acute neck pain, under 6 weeks	2021 analysis, 6 studies, 446 people	Helpful in reducing pain intensity	Reviewers urged caution: small amount of evidence, varied study design
Chronic neck pain, 12 weeks or longer	2019 review, 47 trials, 4,460 people	May reduce pain and improve function	Low to moderate quality
Headache that originates from a problem in the neck	2020 review, 7 studies, 601 people	May reduce frequency and intensity	Reported as a may

The words matter. “Modest” and “small” are the researchers’ words, and so is “may.”

What does that mean for low-back pain?

NCCIH calls spinal manipulation one of several nondrug approaches that may be used for acute and chronic low-back pain. The American College of Physicians, in its 2017 guidelines, said it is one of several therapeutic options that may help, although the strength of the evidence favoring it is low.

Function, in these studies, means how back pain affects things like walking, standing, sleeping and doing household tasks. So when a study reports better function, it is talking about daily life, measured with questionnaires. There is more on back pain after an accident in its own article.

What does it mean for neck pain?

NCCIH says manipulation can be helpful for acute neck pain, and manipulation or mobilization can be helpful for chronic neck pain. For the acute findings, the reviewers said results should be interpreted with caution. For the chronic findings, most of the studies were small and their results were inconsistent. See whiplash and neck pain after a car accident.

Does any of this apply to car accident injuries?

Not directly. The page sorts its evidence by condition and how long the pain has lasted, not by what caused the pain, and it does not report on crash injuries as their own group. It would be overreaching to promise that these numbers predict how an injury from a wreck will respond. That is one more reason treatment here follows your exam findings, and is reassessed along the way.

What side effects should you expect?

A 2017 review of 250 scientific publications reached these conclusions:

• Transient mild-to-moderate side effects often occur after manipulation or mobilization. The most common are increased pain or discomfort, stiffness, or headache.
• Most of those side effects 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.

What about the neck and stroke?

NCCIH addresses this directly. 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, called cervical artery dissections. These tears are rare but can lead to a stroke. Any kind of sudden neck movement, such as playing sports, getting whiplash, or violent vomiting or coughing, may also increase the risk. The available evidence suggests the incidence in people getting manipulation is low, and there is disagreement about whether manipulation can actually cause them. Patients still need to be informed of this potential risk, which is why it is here.

What about pregnancy?

Reports of serious adverse events during pregnancy are very rare, but NCCIH says there has not been much rigorous research on the topic. If you are pregnant and interested in spinal manipulation, discuss the potential risks and benefits with your health care provider.

What should you ask before an adjustment?

NCCIH says it is important for practitioners to assess patients thoroughly and for patients to share information about their health conditions and medications. A few good questions:

• What did my exam show, and why do you recommend this?
• What else could we do instead?
• What side effects should I watch for, and when should I call?
• How will we know if it is not working?

At Total Health & Injury Specialist, you get answers to the first one during the same visit. Adjustments and other therapies may be modified, deferred or avoided when clinically indicated. Signs that point to something more urgent, like numbness or weakness after a wreck, come first.

How does this office use adjustments?

Adjustments are one part of the therapies offered, selected according to your symptoms, exam findings and individual needs. Techniques include Diversified, Thompson, Activator and Gonstead. If you do not show improvement within four weeks, the approach includes a referral for an MRI when clinically appropriate.

Why see Dr. Jackson in Decatur?

Dr. Teresa Jackson earned her Doctorate in Chiropractic at Palmer College of Chiropractic Florida in 2007 and has practiced in Georgia since 2008. Auto accidents are a primary focus of the practice. See how car accident care works, then call (404) 734-9740 or contact the office.