To Manipulate Or Not To Manipulate?

What Is Manipulation?

Manipulation refers to a certain hands-on or manual technique applied to a joint, usually the spine. This technique involves a strong thrust which often leads to a “click” or “pop” sound, and pain relief usually ensues.

The chiropractors tend to use the word “adjustments” which essentially means the same thing.  However, amongst the public and even the medical community, there is some confusion regarding the term manipulation.  Some people regard manipulation as an umbrella of manual techniques, that includes other techniques. Examples are soft/deep tissue massage, mobilization, traction, rolfing, and trigger point release.

The concise definition of manipulation is a technique that winds up the structure to its end range position. A high-velocity thrust follows, and the targeted joint is taken beyond its usual range. The gases trapped in the fluid within the joint surface as the pressure in the joint capsule drops causes the “click” or “pop” to occur. This drop in pressure is from the sudden stretch of the capsule with the thrust. Muscles spasm around the structure relaxes and pain reduces after manipulation.

Effectiveness Of A Manipulation


Clinical experience with manipulation of the lower back is extensive. Controlled observations show that it is possible to produce immediate relief of pain in some cases.  The effectiveness of manipulation is greatest in patients with acute pain, and with no leg pain, numbness or loss of power.  The long term effects of manipulation have, however, not been demonstrated.

Contraindications And Precautions

This technique is relatively aggressive when compared to other manual techniques. Hence, it is important to determine the quality of the joint.

Some contraindications would include :

  1. Fractures in the spine, e.g. spondylolisthesis, or immediately after a whiplash incident as the fracture may not show up on x-rays
  2. Conditions that may make the ligaments weak, e.g. rheumatoid arthritis or cancer
  3. Unstable upper cervical spine. E.g. Your head feels unstable when you look up, and you feel dizzy and vomit after a neck massage
  4. Vertebral artery insufficiency. It is an artery that runs alongside the neck. Because of its anatomy, it travels in a more convoluted manner at C2 level, which is in the upper cervical.  When the upper cervical spine is ready for the manipulation, the blood flow in the artery can be compromised if sclerosis is present in the artery, or the thrust can cause a tear in the vessel.  It is important to ensure that manipulation is done by a professional, even though the risk is small. The risk is only significant when it is done in the upper cervical spine. Those who may be predisposed to this problem often don’t like the neck in extreme position. E.g. hair washing at the saloon with neck tilted backwards.

Precautions to take note of for manipulation would include prolapsed intervertebral disc and nerve impingement.

Manipulation is safe and effective if done properly, and when the above considerations are taken.  It is a very useful tool for a locked joint such as a wry neck, i.e. when you wake up with a neck stuck in a position. A manipulation will allow the neck to regain almost full movement.