Spinal manipulation therapy is an effective way to treat some types of back pain, especially when this pain treatment is started within one month of when the pain started.

Back pain can make you feel as if your body is out of balance — and in some cases, this may actually be the source of your problem. Spinal manipulation therapy is one back pain treatment option that addresses the question of balance and alignment.

Spinal manipulation therapy is a broad term that can include various techniques practiced by chiropractors, doctors of osteopathy (DO), and even some physical therapists. What unites each of these techniques is the use physical force to help promote alignment and ease back pain.

Dennis Minotti, DO, an assistant professor at the University of North Texas Health Science Center in Fort Worth who specializes in the treatment of low back pain, considers spinal manipulation therapy to include “any manual technique treatment for the spine.”

How Spinal Manipulation Therapy Works

According to Dr. Minotti, spinal manipulation therapy seeks to address:

• restriction of range of motion
• muscle spasms or excess tightness
• tenderness or pain
• symmetry and alignment

As these issues are resolved, back pain should become less intense, he says.

Many people with lower back pain experience muscle spasms that lead to impaired blood flow. Manual techniques help to offset this process by improving circulation and increasing oxygen levels in the muscles. Generally, a series of spinal manipulation therapy treatments is necessary to achieve a sustained improvement in back pain symptoms. Chronic or ongoing pain usually requires more treatments than back pain that started suddenly and recently.

Although spinal manipulation therapy can help treat ongoing back pain, it tends to be more effective in acute back pain. Indeed, data suggest that spinal manipulation therapy is most likely to work within one month of the onset of back pain. Minotti points out, however, that many patients end up visiting several doctors before they finally see a specialist who can provide spinal manipulation therapy that works. This delay in therapy likely reduces its effectiveness.

Is Spinal Manipulation Therapy Right For You?

Though many patients with back pain may benefit from spinal manipulation therapy, Minotti says some people may find it less effective than others. People who are extremely overweight or obese, for instance, may experience fewer benefits because:

• Excess weight can prevent proper contact with the muscular tissues that need manipulation
• Excess weight places a burden on the musculoskeletal system, which can worsen pain symptoms

Additionally, people who have degenerative bone or joint diseases (including arthritis) should check with their primary care doctor before beginning spinal manipulation therapy since manual techniques can further weaken fragile bones and joints.

Cons of Spinal Manipulation Therapy

Drawbacks of spinal manipulation therapy include:

• Muscle aches. The most common side effect, especially after the first treatment, is muscle soreness similar to muscle pain after a good workout, says Minotti. Fortunately, this usually eases after the first treatment.
• Cost. Costs vary widely, according to the region of the country and whether patients have health insurance that covers chiropractic or osteopathic treatments. While some insurance companies do cover spinal manipulation therapy, many people may have to pay significant out-of-pocket costs, especially for ongoing treatments.
• Risks. Spinal manipulation therapy is generally safe, but there is a risk of fracturing some bones and, even more rarely, strokes can occur — particularly if blood vessels in the neck are damaged during therapy.

Long Term Outcomes

As with most therapies, long term treatment success depends heavily on what caused the back pain in the first place and on how involved a patient is in preventing future back pain, notes Minotti. Factors that predict sustained back pain relief include:

• Acute back pain. Pain relief is most likely to occur with acute back pain caused by a one-time action or event, such as incorrectly lifting a heavy object.
• Patient involvement. Even after spinal manipulation therapy has ended, patients can continue benefiting from its effects by doing activities that strengthen their back and abdominal muscles, says Minotti. “If a patient was sedentary, did something to hurt their back, and goes back to being sedentary after you help them resolve it, they will probably have back pain again,” he explains.
• Ongoing treatments. For people who have chronic pain, commitment to ongoing pain therapy is essential to gaining and maintaining relief.

Back pain is a common problem, and spinal manipulation therapy is one option for people seeking relief. Just be sure to discuss with your doctor whether it’s the right option for you.