Spinal Manipulative Therapy

Spinal manipulative therapy is a treatment performed by chiropractors and osteopathic physicians and involves manual movements on the body designed to fix dislocations of the synovial joints in the spine. In general, modern medicine is concerned with diagnosing medical problems that can be seen on tests, and treating them accordingly. For this reason, spinal manipulation is deemed controversial among some in modern western medicine. This is because spinal manipulative therapy involves recognizing subtle dislocations of the synovial joints, such as the sacroiliac, lumbosacral, atlanto-axial, atlanto-occipital, costovertebral and costotransverse joints, and the z-joints. These subtle dislocations of the spine often don't show up on radiographic images or blood tests, and often aren't determined by doctors to be the cause of their back pain. Yet chiropractors and osteopaths are trained and skilled in recognizing these subtle dislocations in the spine, and of correcting these problems using various manipulative maneuvers, including a technique known as a high velocity low amplitude (HVLA) thrust. These movements are the high speed thrusts that cause the cracking sound that people may or may not be familiar with. We will describe HVLA thrusts in more detail shortly.

HVLA Technique: Patients who see osteopaths or chiropractors for back pain conditions should bring their medical history with them to their first appointment, as well as any recent X-rays or MRI pictures or CDs. The specialists will look at the information you bring them, as well as put their hands on your body to feel for problems with your spine that may not be apparent on any type of test. If the chiropractor/osteopath recognizes misalignments with your spine, he or she may perform specific movements to shift them back into their proper position.

Spinal Manipulative Therapy involves three or four phases that should culminate in a restoration in the stability of the spine:
  • The preload (or prethrust) phase
  • The thrust phase (in this phase, the physiotherapist may use their arms or the weight of their body to employ one or more quick thrusts to your body to force certain structures back into their proper alignment)
  • The resolution phase


Certain specialists include an orientation phase that would come before the preload phase, if included. If included, the orientation phase would involve turning or orienting the patient in preparation for the next phase. Spinal manipulative therapy is one of the most commonly used non-surgical treatments for lower back pain. This treatment is more common today than it was in the past, for a couple of reasons. The first two reasons are perhaps the most important.
  1. This therapy is more commonly covered by health insurance than it was in the past.
  2. Many patients turn to this type of treatment after the conservative treatments offered by their physicians don't work. These conservative treatments may include anti-inflammatory medications, physical therapy, and steroid injections.
One must also consider this type of treatment doesn't involve medication that will be harmful to the body, and also the good word of mouth that reaches the patients from friends and family members reporting that this type of treatment has helped them.

What is a chiropractic spinal adjustment? Have you already been to a chiropractor before? Has he or she performed a maneuver on your body that caused it to make a "cracking" or "popping" sound? If you have already experienced this type of treatment, you may have remembered what a scary and uneasy feeling it was to suddenly feel your spine move and a loud crack heard inside of it. You may also remember that though the experience was a little startling, it most likely didn't hurt, and that sound you heard was completely normal.

That popping noise you heard as the therapist was performing the thrust maneuver was the swift gentle pressing of the spinal joint. The joints that are stretched during these thrusts are surrounded by sacs of fluid, and pockets of air in these sacs "pop" as the joints are stretched. The joints and sacs surrounding them are not damaged during these adjustments.

You may experience immediate relief in the severity of your symptoms after the joints are re-adjusted. In other cases, tightness are soreness may linger in the nearby muscles, causing the treatment benefits to be delayed.