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Spinal manipulation

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</style><div role="note" class="hatnote navigation-not-searchable">For detail of manipulation in individual synovial joints, see <a href="Joint_manipulation" title="Joint manipulation">Joint manipulation</a>. For the <a href="Chiropractic" title="Chiropractic">chiropractic</a> approach, see <a href="Spinal_adjustment" title="Spinal adjustment">Spinal adjustment</a>.</div>

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</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above">Spinal manipulation</th></tr><tr><td colspan="2" class="infobox-image"><div class="infobox-caption">A <a href="Chiropractic" title="Chiropractic">chiropractor</a> performing a spinal manipulation of the <a href="Thoracic_spine" class="mw-redirect" title="Thoracic spine">thoracic spine</a> on a patient.</div></td></tr><tr><th colspan="2" class="infobox-header"><a href="Alternative_medicine" title="Alternative medicine">Alternative therapy</a></th></tr><tr><th scope="row" class="infobox-label"><a href="Alternative_medicine#NCCIH_classification" title="Alternative medicine">NCCIH Classification</a></th><td class="infobox-data">Manipulative and body-based</td></tr><tr><th scope="row" class="infobox-label"><a href="Regulation_of_alternative_medicine" title="Regulation of alternative medicine">Legality</a></th><td class="infobox-data">Legal in adults, treatment of children varies by jurisdiction</td></tr><tr><th scope="row" class="infobox-label"><a href="Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="http://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?field=uid&term=D020393">D020393</a></td></tr></tbody></table>

Spinal manipulation is an intervention performed on <a href="Synovial_joints" class="mw-redirect" title="Synovial joints">synovial joints</a> of the spine, including the <a href="Zygapophysial" class="mw-redirect" title="Zygapophysial">z-joints</a>, the <a href="Atlanto-occipital_joint" title="Atlanto-occipital joint">atlanto-occipital</a>, <a href="Atlanto-axial_joint" title="Atlanto-axial joint">atlanto-axial</a>, <a href="Vertebral_column" class="mw-redirect" title="Vertebral column">lumbosacral</a>, <a href="Sacroiliac_joint" title="Sacroiliac joint">sacroiliac</a>, <a href="Costotransverse_joint" title="Costotransverse joint">costotransverse</a> and <a href="Costovertebral_joints" title="Costovertebral joints">costovertebral</a> joints. It is typically applied with therapeutic intent, most commonly for the treatment of <a href="Low_back_pain" title="Low back pain">low back pain</a>.<a href="#cite_note-1">[1]</a>

<div class="mw-heading mw-heading2"><h2 id="Effectiveness">Effectiveness</h2></div>

Clinical guidelines from different countries come to different conclusions with respect to spinal manipulation.<a href="#cite_note-2">[2]</a>

A 2012 <a href="Cochrane_review" class="mw-redirect" title="Cochrane review">Cochrane review</a> found that spinal manipulation was as effective as other commonly used therapies.<a href="#cite_note-Rubinstein_2012-3">[3]</a> A 2010 systematic review found that most studies suggest SM achieves equal or superior improvement in pain and function compared with other commonly used interventions for short-, intermediate-, and long-term follow-up.<a href="#cite_note-Dagenais-4">[4]</a> A 2019 systematic review concluded that SM produced comparable results to recommended treatments for chronic low back pain, while SM appeared to give improved results over non-recommended therapies for short-term functional improvement.<a href="#cite_note-auto-5">[5]</a>

In 2007, the <a href="American_College_of_Physicians" title="American College of Physicians">American College of Physicians</a> and the <a href="American_Pain_Society" title="American Pain Society">American Pain Society</a> jointly recommended that clinicians consider spinal manipulation for patients who do not improve with self-care options,<a href="#cite_note-6">[6]</a> and the Clinical Guideline Committee for the American College of Physicians updated the guideline in 2017 to include that non-pharmacological approaches to pain management should be considered, however, that there is only low-quality evidence supporting effectiveness of spinal manipulation.<a href="#cite_note-7">[7]</a> Reviews published in 2008 and 2006 suggested that SM for low back pain was equally effective as other commonly used interventions.<a href="#cite_note-Murphy2006-8">[8]</a><a href="#cite_note-Bronfort-2008-9">[9]</a> A 2007 literature synthesis found good evidence supporting SM and mobilization for low back pain.<a href="#cite_note-Meeker-2007-10">[10]</a> Of four systematic reviews published between 2000 and 2005, one recommended SM and three stated that there was insufficient evidence to make recommendations.<a href="#cite_note-11">[11]</a> A 2017 review concludes "for patients with nonchronic, nonradicular LBP, available evidence does not support the use of spinal manipulation or exercise therapy in addition to standard medical therapy."<a href="#cite_note-RothbergFriedman2017-12">[12]</a>

For neck pain, manipulation and mobilization produce similar changes, and manual therapy and exercise are more effective than other strategies.<a href="#cite_note-13">[13]</a> A 2015 Cochrane systematic review found that there is no high-quality evidence assessing the effectiveness of spinal manipulation for treating neck pain.<a href="#cite_note-Gross2015-14">[14]</a> Moderate-to-low-quality evidence suggests that multiple spinal manipulation sessions may provide improved pain relief and an improvement in function when compared to certain medications.<a href="#cite_note-Gross2015-14">[14]</a> Due to the potential risks associated with spinal manipulation, high-quality randomized controlled trials are needed to determine the clinical role of spinal manipulation.<a href="#cite_note-Gross2015-14">[14]</a> A 2007 systematic review reported that there is moderate- to high-quality evidence that subjects with chronic neck pain, not due to <a href="Whiplash_(medicine)" title="Whiplash (medicine)">whiplash</a> and without arm pain and headaches, show clinically meaningful improvements from a course of spinal manipulation or mobilization.<a href="#cite_note-15">[15]</a> There is not enough evidence to suggest that spinal manipulation is an effective long-term treatment for whiplash, but there are short-term benefits.<a href="#cite_note-16">[16]</a>

<div class="mw-heading mw-heading3"><h3 id="Non-musculoskeletal_disorders">Non-musculoskeletal disorders</h3></div>

Historically, some within the chiropractic profession have claimed that <a href="Spinal_adjustment" title="Spinal adjustment">spinal adjustments</a> have physiological effects on visceral functions and thus affect overall health beyond musculoskeletal conditions. This view originated in the 19th century with <a href="Daniel_David_Palmer" title="Daniel David Palmer">Daniel David Palmer</a>'s original thesis that subluxations caused many diseases. Over time, this hypothesis is inconsistent with our modern understanding of pathology and disease, and only "a small proportion of chiropractors, osteopaths, and other manual medicine providers use[ing] spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial."<a href="#cite_note-Côté_Hartvigsen_Axén_Leboeuf-Yde_2/17/2021-17">[17]</a>

A 2019 global summit of "50 researchers from 8 countries and 28 observers from 18 chiropractic organizations" conducted a systematic review of the literature, and 44 of the 50 "found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function."<a href="#cite_note-Côté_Hartvigsen_Axén_Leboeuf-Yde_2/17/2021-17">[17]</a>

<div class="mw-heading mw-heading3"><h3 id="Assistance_of_medication_or_anesthesia">Assistance of medication or anesthesia</h3></div>

<div role="note" class="hatnote navigation-not-searchable">Further information: <a href="Manipulation_under_anesthesia" title="Manipulation under anesthesia">Manipulation under anesthesia</a></div>

As for manipulation with the assistance of medication or anesthesia, a 2013 review concludes that the best evidence lacks coherence to support its use for chronic spine pain.<a href="#cite_note-18">[18]</a>

<div class="mw-heading mw-heading2"><h2 id="Safety">Safety</h2></div>

<div role="note" class="hatnote navigation-not-searchable">See also: <a href="Spinal_adjustment#Safety" title="Spinal adjustment">Spinal adjustment § Safety</a></div>

There is not sufficient data to establish the safety of spinal manipulations, and the rate of adverse events is unknown.<a href="#cite_note-Gouveia-19">[19]</a><a href="#cite_note-Gross2015-14">[14]</a><a href="#cite_note-Ernst-adverse-20">[20]</a> Spinal manipulation is frequently associated with mild to moderate temporary <a href="Adverse_effects" class="mw-redirect" title="Adverse effects">adverse effects</a>, and also rare serious outcomes which can result in permanent disability or death.<a href="#cite_note-Ernst-adverse-20">[20]</a><a href="#cite_note-21">[21]</a><a href="#cite_note-Gross2015-14">[14]</a><a href="#cite_note-NHSChoicesChiropracticSafety-22">[22]</a> The <a href="National_Health_Service" title="National Health Service">National Health Service</a> in the <a href="United_Kingdom" title="United Kingdom">UK</a> notes that about half of people reported encountering adverse effects following spinal manipulation.<a href="#cite_note-NHSChoicesChiropracticSafety-22">[22]</a> Adverse events are increasingly reported in <a href="Randomized_clinical_trial" class="mw-redirect" title="Randomized clinical trial">randomized clinical trials</a> of spinal manipulation but remain <a href="Under-reporting" title="Under-reporting">under-reported</a> despite recommendations in the 2010 <a href="CONSORT" class="mw-redirect" title="CONSORT">CONSORT</a> guidelines.<a href="#cite_note-Gorrell2016-23">[23]</a><a href="#cite_note-Ernst-2012-24">[24]</a> A 2015 Cochrane systematic review noted that more than half of the randomized controlled trials looking at the effectiveness of spinal manipulation for neck pain, did not include adverse effects in their reports.<a href="#cite_note-Gross2015-14">[14]</a> However, more recent reports have reported spinal manipulation adverse events to be rare.<a href="#cite_note-Mabry-2019-25">[25]</a>

<div class="mw-heading mw-heading3"><h3 id="Risks_of_neck_manipulation">Risks of neck manipulation</h3></div>

The degree of serious <a href="Risk" title="Risk">risks</a> associated with <a href="Cervical_manipulation" class="mw-redirect" title="Cervical manipulation">manipulation of the cervical spine</a> is uncertain, with little evidence of risk of harm but also little evidence of safety either.<a href="#cite_note-Haynes-26">[26]</a><a href="#cite_note-27">[27]</a> There is controversy regarding the degree of risk of <a href="Vertebral_artery_dissection" title="Vertebral artery dissection">vertebral artery dissection</a>, which can lead to <a href="Stroke" title="Stroke">stroke</a> and death, from <a href="Cervical_manipulation" class="mw-redirect" title="Cervical manipulation">cervical manipulation</a>.<a href="#cite_note-Haynes-26">[26]</a> Several deaths have been associated with this technique<a href="#cite_note-Ernst-adverse-20">[20]</a> and it has been suggested that the relationship is <a href="Causative" title="Causative">causative</a>,<a href="#cite_note-Ernst-death-28">[28]</a><a href="#cite_note-Ernst-2010-29">[29]</a> but this is disputed by many chiropractors who believe it is unproven.<a href="#cite_note-Ernst-death-28">[28]</a>

Understandably, vascular accidents are responsible for the major criticism of spinal manipulative therapy. However, it has been pointed out that:<a href="#cite_note-30">[30]</a>

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</style><blockquote class="templatequote"> critics of manipulative therapy emphasize the possibility of serious injury, especially at the brain stem, due to arterial trauma after cervical manipulation. It has required only the very rare reporting of these accidents to malign a therapeutic procedure that, in experienced hands, gives beneficial results with few adverse side effects.</blockquote>

In very rare instances, the manipulative adjustment to the cervical spine of a vulnerable patient becomes the final intrusive act which results in a very serious consequence.<a href="#cite_note-31">[31]</a><a href="#cite_note-32">[32]</a><a href="#cite_note-33">[33]</a><a href="#cite_note-34">[34]</a>

<a href="Edzard_Ernst" title="Edzard Ernst">Edzard Ernst</a> found that there is little evidence for efficacy and some evidence for adverse effects, and due to that, the procedure should be approached with caution, particularly forceful manipulation of the upper spine with rotation.<a href="#cite_note-ernst_safety-35">[35]</a>

A 2007 systematic-review found correlations of mild to moderate adverse effects and less frequently with cervical artery dissection, with unknown incidence.<a href="#cite_note-Ernst-adverse-20">[20]</a>

A 2016 systematic-review found the data supporting a correlation between neck manipulation and cervical artery dissection to be very weak and that there was no convincing evidence for causation.<a href="#cite_note-36">[36]</a>

A 2024 narrative review noted the thromboembolic and thrombotic mechanisms of causation of immediate stroke after cervical spine manipulation that are in the existing peer-reviewed literature.<a href="#cite_note-37">[37]</a>

<div class="mw-heading mw-heading3"><h3 id="Potential_for_incident_under-reporting">Potential for incident under-reporting</h3></div>

Statistics on the reliability of incident reporting for injuries related to manipulation of the cervical spine vary. The <a href="RAND" class="mw-redirect" title="RAND">RAND</a> study assumed that only 1 in 10 cases would have been reported. However, <a href="Edzard_Ernst" title="Edzard Ernst">Edzard Ernst</a> surveyed neurologists in Britain for cases of serious neurological complications occurring within 24 hours of cervical spinal manipulation by various types of practitioners; 35 cases had been seen by the 24 neurologists who responded, but none of the cases had been reported. He concluded that under-reporting was close to 100%, rendering estimates "nonsensical." He therefore suggested that "clinicians might tell their patients to adopt a cautious approach and avoid the type of spinal manipulation for which the risk seems greatest: forceful manipulation of the upper spine with a rotational element."<a href="#cite_note-ernst_safety-35">[35]</a> The NHS Centre for Reviews and Dissemination stated that the survey had methodological problems with data collection.<a href="#cite_note-NHS_Chiro_Maim-38">[38]</a> Both NHS and Ernst noted that bias is a problem with the survey method of data collection.

A 2001 study in the journal Stroke found that vertebrobasilar accidents (VBAs) were five times more likely in those aged less than 45 years who had visited a chiropractor in the preceding week, compared to controls who had not visited a chiropractor. No significant associations were found for those over 45 years. The authors concluded: "While our analysis is consistent with a positive association in young adults... The rarity of VBAs makes this association difficult to study despite high volumes of chiropractic treatment."<a href="#cite_note-39">[39]</a> The NHS notes that this study collected data objectively by using administrative data, involving less recall bias than survey studies, but the data were collected retrospectively and probably contained inaccuracies.<a href="#cite_note-NHS_Chiro_Maim-38">[38]</a>

<div class="mw-heading mw-heading3"><h3 id="Mis-attribution_problems">Mis-attribution problems</h3></div>

Studies of stroke and manipulation do not always clearly identify what professional has performed the manipulation. In some cases this has led to confusion and improper placement of blame. In a 1995 study, chiropractic researcher Allan Terrett, DC, pointed to this problem:<a href="#cite_note-Terrett-40">[40]</a>

<blockquote class="templatequote"> The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with SMT injury by medical authors, respected medical journals and medical organizations. In many cases, this is not accidental; the authors had access to original reports that identified the practitioner involved as a nonchiropractor. The true incidence of such reporting cannot be determined. Such reporting adversely affects the reader's opinion of chiropractic and chiropractors.</blockquote>

This error was taken into account in a 1999 review<a href="#cite_note-Di_Fabio-41">[41]</a> of the scientific literature on the risks and benefits of manipulation of the cervical spine (MCS). Special care was taken, whenever possible, to correctly identify all the professions involved, as well as the type of manipulation responsible for any injuries and/or deaths. It analyzed 177 cases that were reported in 116 articles published between 1925 and 1997, and summarized:<a href="#cite_note-Di_Fabio-41">[41]</a>

<blockquote class="templatequote"> The most frequently reported injuries involved arterial dissection or spasm, and lesions of the brain stem. Death occurred in 32 (18%) of the cases. Physical therapists were involved in less than 2% of the cases, and no deaths have been attributed to MCS provided by physical therapists. Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (non-thrust passive movements).</blockquote>

In Figure 1 in the review, the types of injuries attributed to manipulation of the cervical spine are shown,<a href="#cite_note-42">[42]</a> and Figure 2 shows the type of practitioner involved in the resulting injury.<a href="#cite_note-43">[43]</a> For the purpose of comparison, the type of practitioner was adjusted according to the findings by Terrett.<a href="#cite_note-Terrett-40">[40]</a>

The review concluded: "The literature does not demonstrate that the benefits of MCS outweigh the risks. Several recommendations for future studies and for the practice of MCS are discussed."<a href="#cite_note-Di_Fabio-41">[41]</a>

<div class="mw-heading mw-heading2"><h2 id="History">History</h2></div>

Spinal manipulation is a therapeutic intervention that has roots in <a href="Traditional_medicine" title="Traditional medicine">folk medicine</a> such as the <a href="Traditional_bone-setting" title="Traditional bone-setting">traditional bone-setting</a> and has been used by various cultures, apparently for thousands of years. <a href="Hippocrates" title="Hippocrates">Hippocrates</a>, the "father of medicine" used manipulative techniques,<a href="#cite_note-Swedlo-44">[44]</a> as did the ancient Egyptians and many other cultures.<a href="#cite_note-Burke-45">[45]</a> A modern re-emphasis on <a href="Manipulative_therapy" class="mw-redirect" title="Manipulative therapy">manipulative therapy</a> occurred in the late 19th century in North America with the emergence of <a href="Osteopathic" class="mw-redirect" title="Osteopathic">osteopathic</a> and <a href="Chiropractic" title="Chiropractic">chiropractic</a> medicine.<a href="#cite_note-Keating-pathways-46">[46]</a> Spinal manipulative therapy gained recognition by mainstream medicine during the 1960s.<a href="#cite_note-Burke2-47">[47]</a><a href="#cite_note-titleInternational_MUA_Academy_of_Physicians_-_Historical_Considerations-48">[48]</a>

<div class="mw-heading mw-heading2"><h2 id="Providers">Providers</h2></div>

In <a href="North_America" title="North America">North America</a>, it is most commonly performed by <a href="Chiropractor" class="mw-redirect" title="Chiropractor">chiropractors</a>, <a href="Doctor_of_Osteopathic_Medicine" title="Doctor of Osteopathic Medicine">osteopathic physicians</a>, and <a href="Physical_therapist" class="mw-redirect" title="Physical therapist">physical therapists</a>. In <a href="Europe" title="Europe">Europe</a>, <a href="Osteopaths" class="mw-redirect" title="Osteopaths">osteopaths</a>, <a href="Chiropractors" class="mw-redirect" title="Chiropractors">chiropractors</a>, and <a href="Physiotherapists" class="mw-redirect" title="Physiotherapists">physiotherapists</a> are the majority providers, although the precise figure varies between countries. In 1992, chiropractors were estimated to perform over 90% of all manipulative treatments given for low back pain treatment in the USA.<a href="#cite_note-shekelle-49">[49]</a> A 2012 survey in the US found that 99% of the first-professional physical therapy programs that responded were teaching some form of thrust <a href="Joint_manipulation" title="Joint manipulation">joint manipulation</a>.<a href="#cite_note-50">[50]</a>

<div class="mw-heading mw-heading2"><h2 id="Terminology">Terminology</h2></div>

Manipulation has been known by several other names. Chiropractors often refer to manipulation of a spinal joint as an '<a href="Spinal_adjustment" title="Spinal adjustment">adjustment</a>'. Following the labeling system developed by Geoffery Maitland,<a href="#cite_note-51">[51]</a> manipulation is synonymous with Grade V <a href="Joint_mobilization" title="Joint mobilization">mobilization</a>. Because of its distinct segmental biomechanics (see section below), the term <a href="High_velocity_low_amplitude_thrust" class="mw-redirect" title="High velocity low amplitude thrust">high velocity low amplitude</a> (HVLA) thrust is often used interchangeably with manipulation. However, it is important to note that the magnitude of neither force, velocity, or amplitude are regarded as defining attributes.<a href="#cite_note-evans_lucas_2023-52">[52]</a><a href="#cite_note-pmid36494698-53">[53]</a>

<div class="mw-heading mw-heading2"><h2 id="Biomechanics">Biomechanics</h2></div>

Spinal manipulation can be distinguished from other <a href="Manual_therapy" title="Manual therapy">manual therapy</a> interventions such as <a href="Joint_mobilization" title="Joint mobilization">mobilization</a> by its <a href="Biomechanics" title="Biomechanics">biomechanics</a>, both <a href="Dynamics_(physics)" class="mw-redirect" title="Dynamics (physics)">kinetics</a> and <a href="Kinematics" title="Kinematics">kinematics</a>.

<div class="mw-heading mw-heading3"><h3 id="Kinetics">Kinetics</h3></div>

Force-time profiles measured during spinal manipulation were originally described as consisting of three distinct phases: the 'preload' phase, the 'thrust' (or '<a href="Impulse_(physics)" title="Impulse (physics)">impulse</a>') phase, and the 'resolution' phase.<a href="#cite_note-54">[54]</a> Evans and Breen<a href="#cite_note-55">[55]</a> added a fourth 'orientation' phase to describe the first period, during which the patient is oriented into the appropriate position in preparation for the preload phase.

<div class="mw-heading mw-heading3"><h3 id="Kinematics">Kinematics</h3></div>

The <a href="Kinematics" title="Kinematics">kinematics</a> of a complete <a href="Functional_spinal_unit" title="Functional spinal unit">spinal motion segment</a>, when one of its constituent spinal joints is manipulated, are much more complex than the kinematics that occur during manipulation of an independent peripheral <a href="Synovial_joint" title="Synovial joint">synovial joint</a>. However, the events that take place in a manipulated synovial joint are the same, irrespective of whether the synovial joint in the spine or the periphery. Evans and Lucas defined manipulation using these events:<a href="#cite_note-evans_lucas_2023-52">[52]</a> "Separation (gapping) of opposing articular surfaces of a synovial joint, caused by a force applied perpendicularly to those articular surfaces, that results in cavitation within the <a href="Synovial_fluid" title="Synovial fluid">synovial fluid</a> of that joint." The corresponding definition for the mechanical response of a manipulation is: "Separation (gapping) of opposing articular surfaces of a synovial joint that results in cavitation within the synovial fluid of that joint." In turn, the action of a manipulation can be defined as: "A force applied perpendicularly to the articular surfaces."

<div class="mw-heading mw-heading2"><h2 id="Suggested_mechanisms">Suggested mechanisms</h2></div>

The effects of spinal manipulation have been shown to include:

<ul><li>Temporary relief of musculoskeletal <a href="Pain" title="Pain">pain</a></li>

<li>Shortened time to recover from <a href="Acute_(medical)" class="mw-redirect" title="Acute (medical)">acute</a> <a href="Back_pain" title="Back pain">back pain</a></li>

<li>Temporary increase in passive range of motion (ROM)</li>

<li>Physiological effects on the central nervous system (specifically the <a href="Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic nervous system</a>)<a href="#cite_note-Murphy1995-56">[56]</a><a href="#cite_note-Kingston2014-57">[57]</a></li>

<li>Altered sensorimotor integration</li>

<li>No alteration of the position of the sacroiliac joint<a href="#cite_note-Tullberg-58">[58]</a></li>

<li>Sham or <a href="Placebo" title="Placebo">placebo</a> manipulation<a href="#cite_note-auto-5">[5]</a></li></ul>

Common <a href="Adverse_effect" title="Adverse effect">side effects</a> of spinal manipulation are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort.<a href="#cite_note-59">[59]</a>

<ul><li><a href="Joint_manipulation" title="Joint manipulation">Joint manipulation</a></li>

<li><a href="Joint_mobilization" title="Joint mobilization">Joint mobilization</a></li>

<li><a href="Osteopathic_manipulation" class="mw-redirect" title="Osteopathic manipulation">Osteopathic manipulation</a></li>

<li><a href="Spinal_adjustment" title="Spinal adjustment">Spinal adjustment</a></li></ul>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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<ul><li>Lay summary in: <cite class="citation news cs1"><a rel="nofollow" class="external text" href="http://news.bbc.co.uk/2/hi/health/4824594.stm">"Back treatment 'has few benefits'"</a>. BBC News. 2006-03-22.</cite></li></ul>

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<ul><li>Lay summary in: <cite class="citation news cs1"><a rel="nofollow" class="external text" href="http://www.medicalnewstoday.com/articles/75754.php">"Spinal Manipulation Should Not Be Routinely Used, New Study Warns"</a>. Medical News Today. 2007-07-02.</cite></li></ul>

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<li id="cite_note-titleInternational_MUA_Academy_of_Physicians_-_Historical_Considerations-48"><a href="#cite_ref-titleInternational_MUA_Academy_of_Physicians_-_Historical_Considerations_48-0">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.muaphysicians.com/historical.html">"International MUA Academy of Physicians - Historical Considerations"</a>. Retrieved 2008-03-24.</cite>

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<li id="cite_note-shekelle-49"><a href="#cite_ref-shekelle_49-0">^</a> <cite id="CITEREFShekelleAdamsChassinHurwitz1992" class="citation journal cs1">Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH (October 1992). "Spinal manipulation for low-back pain". Annals of Internal Medicine. 117 (7): 590–8. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.7326%2F0003-4819-117-7-590">10.7326/0003-4819-117-7-590</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/1388006">1388006</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:35702578">35702578</a>.</cite>

</li>

<li id="cite_note-50"><a href="#cite_ref-50">^</a> <cite id="CITEREFNoteboomLittleBoissonnault2015" class="citation journal cs1">Noteboom JT, Little C, Boissonnault W (June 2015). "Thrust joint manipulation curricula in first-professional physical therapy education: 2012 update". The Journal of Orthopaedic and Sports Physical Therapy. 45 (6): 471–6. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.2519%2Fjospt.2015.5273">10.2519/jospt.2015.5273</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25899212">25899212</a>.</cite>

</li>

<li id="cite_note-51"><a href="#cite_ref-51">^</a> Maitland, G.D. Peripheral Manipulation 2nd ed. Butterworths, London, 1977. Maitland, G.D. Vertebral Manipulation 5th ed. Butterworths, London, 1986.

</li>

<li id="cite_note-evans_lucas_2023-52">^ <a href="#cite_ref-evans_lucas_2023_52-0">a</a> <a href="#cite_ref-evans_lucas_2023_52-1">b</a> <cite id="CITEREFEvansLucas2023" class="citation journal cs1 cs1-prop-long-vol">Evans DW, Lucas N (2023). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10015914">"What is manipulation? A new definition"</a>. BMC Musculoskelet Disord. 15, 24(1) (1): 194. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1186%2Fs12891-023-06298-w">10.1186/s12891-023-06298-w</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10015914">10015914</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/36918833">36918833</a>.</cite>

</li>

<li id="cite_note-pmid36494698-53"><a href="#cite_ref-pmid36494698_53-0">^</a> <cite id="CITEREFEvans2022" class="citation journal cs1">Evans DW (2022). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733235">"Why is the prevailing model of joint manipulation (still) incorrect?"</a>. Chiropr Man Ther. 30 (1): 51. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1186%2Fs12998-022-00460-2">10.1186/s12998-022-00460-2</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733235">9733235</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/36494698">36494698</a>.</cite>

</li>

<li id="cite_note-54"><a href="#cite_ref-54">^</a> <cite id="CITEREFHerzogSymons2001" class="citation journal cs1">Herzog W, Symons B (2001). "The biomechanics of spinal manipulation". Crit Rev Phys Rehabil Med. 13 (2): 191–216. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1615%2FCritRevPhysRehabilMed.v13.i2-3.50">10.1615/CritRevPhysRehabilMed.v13.i2-3.50</a>.</cite>

</li>

<li id="cite_note-55"><a href="#cite_ref-55">^</a> <cite id="CITEREFEvansBreen2006" class="citation journal cs1">Evans DW, Breen AC (January 2006). "A biomechanical model for mechanically efficient cavitation production during spinal manipulation: prethrust position and the neutral zone". Journal of Manipulative and Physiological Therapeutics. 29 (1): 72–82. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.jmpt.2005.11.011">10.1016/j.jmpt.2005.11.011</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16396734">16396734</a>.</cite>

</li>

<li id="cite_note-Murphy1995-56"><a href="#cite_ref-Murphy1995_56-0">^</a> <cite id="CITEREFMurphyDawsonSlack1995" class="citation journal cs1">Murphy BA, Dawson NJ, Slack JR (March 1995). "Sacroiliac joint manipulation decreases the H-reflex". Electromyography and Clinical Neurophysiology. 35 (2): 87–94. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/7781578">7781578</a>.</cite>

</li>

<li id="cite_note-Kingston2014-57"><a href="#cite_ref-Kingston2014_57-0">^</a> <cite id="CITEREFKingstonClaydonTumilty2014" class="citation journal cs1">Kingston L, Claydon L, Tumilty S (August 2014). "The effects of spinal mobilizations on the sympathetic nervous system: a systematic review". Manual Therapy. 19 (4): 281–7. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.math.2014.04.004">10.1016/j.math.2014.04.004</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24814903">24814903</a>.</cite>

</li>

<li id="cite_note-Tullberg-58"><a href="#cite_ref-Tullberg_58-0">^</a> <cite id="CITEREFTullbergBlombergBranthJohnsson1998" class="citation journal cs1">Tullberg T, Blomberg S, Branth B, Johnsson R (May 1998). "Manipulation does not alter the position of the sacroiliac joint. A roentgen stereophotogrammetric analysis". Spine. 23 (10): 1124–8, discussion 1129. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00007632-199805150-00010">10.1097/00007632-199805150-00010</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/9615363">9615363</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:36480639">36480639</a>. <q>Because the supposed positive effects are not a result of a reduction of subluxation, further studies of the effects of manipulation should focus on the soft tissue response.</q></cite>

</li>

<li id="cite_note-59"><a href="#cite_ref-59">^</a> <cite id="CITEREFSenstadLeboeuf-YdeBorchgrevink1997" class="citation journal cs1">Senstad O, Leboeuf-Yde C, Borchgrevink C (February 1997). "Frequency and characteristics of side effects of spinal manipulative therapy". Spine. 22 (4): 435–40, discussion 440-1. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00007632-199702150-00017">10.1097/00007632-199702150-00017</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/9055373">9055373</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:7482895">7482895</a>.</cite>

</li>

</ol></div>

<div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2></div>

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<ul><li><cite id="CITEREFCyriax1982" class="citation book cs1">Cyriax J (1982). Textbook of Orthopaedic Medicine: Diagnosis of Soft Tissue Lesions. Vol. I (8th ed.). London: Bailliere Tindall.</cite></li>

<li><cite id="CITEREFCyriax1983" class="citation book cs1">Cyriax J (1983). Textbook of Orthopaedic Medicine: Treatment by Manipulation, Massage and Injection. Vol. II (10th ed.). London: Bailliere Tindall.</cite></li>

<li><cite id="CITEREFGreive1994" class="citation book cs1">Greive (1994). Modern Manual Therapy of the Vertebral Column. Harcourt Publishers Ltd.</cite></li>

<li><cite id="CITEREFMaitland1977" class="citation book cs1">Maitland GD (1977). Peripheral Manipulation (2nd ed.). London: Butterworths.</cite></li>

<li><cite id="CITEREFMaitland1986" class="citation book cs1">Maitland GD (1986). ertebral Manipulation (5th ed.). London: Butterworths.</cite></li>

<li><cite id="CITEREFMcKenzie1981" class="citation book cs1">McKenzie RA (1981). The Lumbar Spine; Mechanical Diagnosis and Therapy. Waikanae, New Zealand: Spinal Publications.</cite></li>

<li><cite id="CITEREFMcKenzie1990" class="citation book cs1">McKenzie RA (1990). The Cervical and Thoracic Spine; Mechanical Diagnosis and Therapy. Waikanae, New Zealand: Spinal Publications.</cite></li>

<li><cite id="CITEREFMennel1964" class="citation book cs1">Mennel JM (1964). Joint Pain; Diagnosis and Treatment Using Manipulative Techniques. Boston: Little Brown and Co.</cite></li></ul>

</div>

<div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2></div>

<ul><li><a rel="nofollow" class="external text" href="https://web.archive.org/web/19981206122239/http://www.aaompt.org/">American Academy of Orthopedic Manual Physical Therapy (AAOMPT)</a></li>

<li><a rel="nofollow" class="external text" href="http://www.manipulativetherapy.org/">Canadian Academy of Manipulative Therapy (CAMT)</a></li>

<li><a rel="nofollow" class="external text" href="http://orthopractic.org/">Canadian Orthopractic Manual Therapy Association (COMTA)</a></li>

<li><a rel="nofollow" class="external text" href="https://web.archive.org/web/20080828022608/http://www.ifomt.org/">International Federation of Orthopaedic Manipulative Therapists (IFOMT)</a></li>

<li><a rel="nofollow" class="external text" href="http://jmmtonline.com/">Journal of Manual and Manipulative Therapy (JMMT)</a></li>

<li><a rel="nofollow" class="external text" href="http://www.sofmmoo.com/english_section/2_neck_pain/Cervical%20Manip.%20Recommandation%20SOFMMOO.htm">Prevention of the vertebrobasilar accidents following cervical thrust manipulations</a>: recommendations of the French Society of Orthopaedic and Osteopathic Manual Medicine (SOFMMOO).</li>

<li><a rel="nofollow" class="external text" href="http://www.manual-med.com">European Association of Advanced Manual and Manipulative Therapy</a></li></ul>

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</style><div id="Chiropractic241" style="font-size:114%;margin:0 4em"><a href="Chiropractic" title="Chiropractic">Chiropractic</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Chiropractic</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="History_of_chiropractic" title="History of chiropractic">History</a></li>

<li><a href="Sports_chiropractic" title="Sports chiropractic">Sports chiropractic</a></li>

<li><a href="Veterinary_chiropractic" title="Veterinary chiropractic">Veterinary chiropractic</a></li>

<li><a href="Chiropractic_controversy_and_criticism" title="Chiropractic controversy and criticism">Controversy and criticism</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Chiropractic_treatment_techniques" title="Chiropractic treatment techniques">Techniques</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Neck_manipulation" title="Neck manipulation">Cervical manipulation</a></li>

<li><a href="Activator_technique" title="Activator technique">Activator technique</a></li>

<li><a href="Chiropractic_treatment_techniques#Gonstead_technique" title="Chiropractic treatment techniques">Gonstead technique</a></li>

<li><a href="Chiropractic_treatment_techniques#Koren_Specific_Technique" title="Chiropractic treatment techniques">Koren Specific Technique</a></li>

<li><a href="Manual_therapy" title="Manual therapy">Manual therapy</a></li>

<li><a href="Myofascial_release" title="Myofascial release">Myofascial release</a></li>

<li><a href="Spinal_adjustment" title="Spinal adjustment">Spinal adjustment</a></li>

<li><a href="Torque_release_technique" class="mw-redirect" title="Torque release technique">Torque release technique</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Chiropractic_education" title="Chiropractic education">Education</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="List_of_chiropractic_schools" title="List of chiropractic schools">Schools</a></li>

<li><a href="List_of_chiropractic_credentials" title="List of chiropractic credentials">Credentials</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Accrediting bodies</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">International organizations</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="List_of_people_in_chiropractic" title="List of people in chiropractic">People</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Daniel_David_Palmer" title="Daniel David Palmer">D.D. Palmer</a></li>

<li><a href="B._J._Palmer" title="B. J. Palmer">B.J. Palmer</a></li>

<li><a href="Joseph_C._Keating_Jr." title="Joseph C. Keating Jr.">Joseph C. Keating Jr.</a></li>

<li><a href="Joseph_Janse" title="Joseph Janse">Joseph Janse</a></li>

<li><a href="Clarence_Gonstead" title="Clarence Gonstead">Clarence Gonstead</a></li>

<li><a href="Tedd_Koren" title="Tedd Koren">Tedd Koren</a></li></ul>

</div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div>

<ul><li>Category</li></ul>

</div></td></tr></tbody></table></div></div><div><div class="zim-footer">

This article is issued from <a class="external text" title="Last edited on 2025-06-20" href="https://en.wikipedia.org/wiki/?title=Spinal_manipulation&oldid=1296438240">Wikipedia</a>. The text is available under <a class="external text" href="https://creativecommons.org/licenses/by-sa/4.0/deed.en">Creative Commons Attribution-Share Alike 4.0</a> unless otherwise noted. Additional terms may apply for the media files.

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