The Back & Neck Handbook

An independent, plain-English guide to back, neck and sports-injury care

Care and safety

Spinal manipulation, adjustment and mobilization explained

"Manipulation", "adjustment", "mobilization": the words sound technical and are often used loosely. This page explains what each one means, who uses these techniques, and what the National Center for Complementary and Integrative Health says about their safety. It does not say whether they work for any condition; that is a question for the published research and for a health care provider who knows you.

Spinal manipulation

NCCIH, in its fact sheet Spinal Manipulation: What You Need To Know, describes spinal manipulation as a technique in which 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 move on its own. Manipulation is usually quick, and the person receiving it does not control the movement.

Adjustment

"Adjustment" is the word chiropractors commonly use for a manipulation. MedlinePlus, in its overview of chiropractic, puts it directly: chiropractors perform adjustments, which are manipulations, to the spine or other parts of the body. In everyday conversation the two words usually mean the same thing.

Mobilization

NCCIH distinguishes spinal manipulation from spinal mobilization. Mobilization, it explains, does not involve a thrust, is performed within a joint's natural range of motion, and can be controlled by the patient. In practice, mobilization often looks like slow, repeated, gentle movements of a joint, sometimes with the practitioner's hands guiding it back and forth.

Who uses these techniques

NCCIH notes that most spinal manipulations are done by chiropractors, and that chiropractic treatment often involves spinal manipulation, but that other licensed professionals, including osteopathic physicians and physical therapists, also use the technique. Mobilization is widely used by physical therapists as well. The What chiropractic is page explains how chiropractors are educated and licensed.

What a session may involve

Before any hands-on technique, a practitioner would normally take a health history and examine the area, and NCCIH notes that practitioners should assess patients thoroughly. During a manipulation, the person usually lies or sits in a particular position while the practitioner positions the joint and applies a short, quick thrust. Many people hear a pop or click. That sound is generally attributed to a release of gas within the fluid of the joint rather than to bones moving back into place. Mobilization is usually quieter and slower. It is always reasonable to ask a practitioner to explain what they intend to do before they do it, and to say no to any technique you are not comfortable with.

The safety picture

NCCIH's fact sheet summarises a large review of research on the risks and side effects of spinal manipulation and mobilization. Its conclusions, in plain words:

  • Mild side effects are common and short-lived. Temporary, mild-to-moderate side effects, most often increased pain or discomfort, stiffness or headache, often occur after spinal manipulation or mobilization, and most go away quickly.
  • Serious side effects are very rare. Serious problems, such as serious spinal or neurological problems or strokes involving arteries in the neck, have been reported, but they are very rare, and NCCIH notes that there are no accurate estimates of how often they occur.
  • Underlying health problems matter. The likelihood of a serious side effect may be greater in people who have underlying health problems that increase their risk of injury.

For that reason, NCCIH stresses that it is important for practitioners to assess patients thoroughly and for patients to share information about their health conditions and medications with the practitioner.

Questions worth raising

If you are considering any hands-on treatment for your back or neck, these are sensible things to raise with the practitioner and with your regular doctor:

  • your full health history, including any conditions affecting your bones, joints, blood vessels or blood clotting, and any recent injury;
  • all the medicines you take;
  • whether a thrust technique is planned, or whether gentler methods are an option;
  • what side effects to expect and which symptoms should make you seek help straight away;
  • how progress will be judged, and what happens if things do not change.

Any new or unusual symptom after a manipulation of the neck, such as sudden severe headache, dizziness, trouble speaking, vision changes, numbness or weakness, needs urgent medical attention. The When to see a doctor page lists other warning signs, and the before a first visit page has a fuller list of questions.