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Low Back Pain: Should I Have Spinal Manipulation?

Low Back Pain: Should I Have Spinal Manipulation?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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Low Back Pain: Should I Have Spinal Manipulation?

Get the facts

Your options

  • Have spinal manipulation for your low back pain.
  • Don't have spinal manipulation.

If your symptoms are very bad or are getting worse, or if you're getting new symptoms, be sure to tell your doctor. Manipulation may not be the right treatment for you.

Key points to remember

  • Most people with low back pain get better with home treatment. Try using ice, moist heat, pain relievers, and mild exercise.
  • Certain symptoms, such as sharp pain or low back pain with leg pain or numbness, can be a sign of a serious condition.
  • Like most low back pain treatments, spinal manipulation works for some people, but not for others.
  • No matter what treatment you use for low back pain, you'll also need to learn how to take care of your back and do exercises that help your muscles better support your joints.
  • If spinal manipulation leads to more pain, new pain, or numbness in your legs or anywhere else, you should stop this treatment.
FAQs

What is spinal manipulation?

Spinal manipulation involves working on the head, shoulders, neck, back, or hips to help relieve back pain. It can range from massage and slow pressing to a quick thrust.

Sometimes heat, ultrasound, or electrical current is used first to relax your muscles.

This is the basis of chiropractic treatment. But not only chiropractors are trained to do spinal manipulation. Others include:

Local laws may vary as to who can do spinal manipulation.

How well does spinal manipulation work for low back pain?

For low back pain that has lasted less than about 12 weeks, it is not clear whether spinal manipulation is helpful. 1

Spinal manipulation has been shown to relieve back pain for some people, but not others. This is true for all back pain treatments.

Some practitioners encourage long-term treatment to prevent future problems. Long-term treatment needs more study to support it as a proven practice.

To keep your back healthy, learn how to take care of your back. Make a habit of strengthening your muscles so that they better support your spine.

How do you choose someone to do spinal manipulation?

Look for someone who:

  • Is willing to coordinate treatment with your other health care providers
  • Will tell you about home treatment and exercises.
  • Diagnoses problems with a physical exam and an interview, using X-ray in unusual cases.
  • Is willing to refer you to a specialist when needed. This may include an orthopedist, neurosurgeon, or oncologist for further testing, or a registered dietitian for nutritional counseling.

Avoid someone who:

  • Uses X-rays as a standard diagnostic test, especially full-body X-rays or X-rays of children. These give unnecessarily high levels of radiation.
  • Uses manipulation to treat such problems as lung and ear infections, skin conditions, eye problems, and learning disabilities.
  • Promotes regular manipulation as a way to prevent illness or joint problems.

What are the risks of spinal manipulation?

Slow pressing movement, sometimes called mobilization, has no known risks.

Certain symptoms, such as sharp pain or low back pain with leg pain or numbness, can be a sign of a serious condition that needs medical treatment right away. If you have these symptoms, spinal manipulation may not be the right treatment for you.

If manipulation leads to more pain, new pain, or numbness in the legs or anywhere else, stop the treatment.

When might you consider spinal manipulation?

  • Your symptoms aren't caused by any serious conditions.
  • You have tried home treatments for a few weeks, and your back pain is not better.
  • You want to avoid using medication.
  • You have tried manipulation in the past and have been satisfied.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have spinal manipulation Have spinal manipulation
  • You lie on a special table while the practitioner puts pressure on your head, shoulders, back, or hips. The treatment can range from slow pressing to a quick thrust.
  • Some people get pain relief.
  • Slow pressing has no known risks.
  • Although it is very rare, forceful or rapid movements, especially to the neck, may cause problems. Manipulation is not recommended for people who have nerve-related problems that are very severe or getting worse. 2, 1
Use other treatment Use other treatment
  • You can apply ice or heat to your back, find a comfortable position when you rest, and exercise regularly.
  • You can take pain medicine.
  • For most people, home treatments relieve low back pain within 4 to 6 weeks.
  • Some people keep having back pain even with home treatment.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Read More
close

Personal stories about spinal manipulation for low back pain

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I grew up in a family that swears by spinal manipulation. When I moved out on my own in another city, I went to the chiropractor down the street from me when I hurt my back. I didn't feel comfortable. This guy was totally different from my old chiropractor—he wanted to use some treatments that have nothing to do with my spine. I talked to some friends and to my doctor and found a good chiropractor that way.

Tara, age 24

I've put up with bouts of this back pain over the years, but this time I couldn't walk right. After a couple of days, a friend of mine suggested I see his osteopathic doctor to have my spine worked on. I didn't know much about spinal manipulation, but I thought I'd give it a try. And you know, after just one visit, my pain got a lot better.

Joe, age 40

I'm pretty careful about who I choose for my medical care. So I did some research before going to see someone about treating my back pain. I'd heard about some people who actually felt worse after spinal manipulation. I'd also heard from friends that manipulation helped them a lot. So I talked to my doctor and got the names of a physical therapist and a chiropractor. I talked to each of them on the phone ahead of time about how they practice. They both sounded great. After I made sure that both were covered by my health insurance, it was a toss-up. I took the first appointment that was available. A few appointments and daily exercises at home have brought me such relief!

Sandra, age 37

I hurt my back from using a posthole digger, and I also had pain in the back of my thigh. I went to the guy who worked on my friend's back, and he had me get an X-ray and gave me a spinal adjustment. After a week of seeing him, I began having pain farther down my leg, into my calf. I went to my family doctor and eventually I had a test called an MRI. It showed that I had a herniated disc. I'll hold off on manipulation and try some other treatments for now.

Dave, age 55

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose spinal manipulation

Reasons not to choose spinal manipulation

I am comfortable with treatment that involves hands-on contact.

I don't like the idea of treatments that involve physical contact.

More important
Equally important
More important

I want to avoid using medication for my pain.

Medication or another treatment will help relieve my pain.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Trying spinal manipulation

NOT trying spinal manipulation

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Do most people with low back pain get better with home treatment?

  • Yes That's right. For most people, home treatments—such as ice, moist heat, pain relievers, and mild exercise—relieve low back pain within 4 to 6 weeks.
  • No No, that's wrong. For most people, home treatments—such as ice, moist heat, pain relievers, and mild exercise—relieve low back pain within 4 to 6 weeks.
  • I'm not sure It may help to go back and read "Compare Your Options." Research shows that for most people, home treatments—such as ice, moist heat, pain relievers, and mild exercise—relieve low back pain within 4 to 6 weeks.
2.

Is spinal manipulation a back pain treatment that works for everyone?

  • Yes Sorry, that's wrong. This treatment works for some people but not others.
  • No Correct. This treatment works for some people but not others.
  • I'm not sure It may help to go back and read "Get the Facts." This treatment doesn't work for everyone.
3.

Should you stop treatment right away if a spinal manipulation makes your pain worse or causes new pain in your legs or anywhere else?

  • Yes You're right. Sharp pain or low back pain with leg pain or numbness can be signs of a serious condition that needs medical treatment right away.
  • No Sorry, but the right answer is "yes." Sharp pain or low back pain with leg pain or numbness can be signs of a serious condition that needs medical treatment right away.
  • I'm not sure It may help to go back and read "Get the Facts." Sharp pain or low back pain with leg pain or numbness can be signs of a serious condition that needs medical treatment right away.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

What matters to you  

Credits and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics
References
Citations
  1. McIntosh G, Hall H (2011). Low back pain (acute), search date December 2009. Online version of BMJ Clinical Evidence : http://www.clinicalevidence.com.
  2. Binder A (2008). Neck pain, search date May 2007. Online version of BMJ Clinical Evidence : http://www.clinicalevidence.com.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Low Back Pain: Should I Have Spinal Manipulation?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Have spinal manipulation for your low back pain.
  • Don't have spinal manipulation.

If your symptoms are very bad or are getting worse, or if you're getting new symptoms, be sure to tell your doctor. Manipulation may not be the right treatment for you.

Key points to remember

  • Most people with low back pain get better with home treatment. Try using ice, moist heat, pain relievers, and mild exercise.
  • Certain symptoms, such as sharp pain or low back pain with leg pain or numbness, can be a sign of a serious condition.
  • Like most low back pain treatments, spinal manipulation works for some people, but not for others.
  • No matter what treatment you use for low back pain, you'll also need to learn how to take care of your back and do exercises that help your muscles better support your joints.
  • If spinal manipulation leads to more pain, new pain, or numbness in your legs or anywhere else, you should stop this treatment.
FAQs

What is spinal manipulation?

Spinal manipulation involves working on the head, shoulders, neck, back, or hips to help relieve back pain. It can range from massage and slow pressing to a quick thrust.

Sometimes heat, ultrasound, or electrical current is used first to relax your muscles.

This is the basis of chiropractic treatment. But not only chiropractors are trained to do spinal manipulation. Others include:

Local laws may vary as to who can do spinal manipulation.

How well does spinal manipulation work for low back pain?

For low back pain that has lasted less than about 12 weeks, it is not clear whether spinal manipulation is helpful. 1

Spinal manipulation has been shown to relieve back pain for some people, but not others. This is true for all back pain treatments.

Some practitioners encourage long-term treatment to prevent future problems. Long-term treatment needs more study to support it as a proven practice.

To keep your back healthy, learn how to take care of your back. Make a habit of strengthening your muscles so that they better support your spine.

How do you choose someone to do spinal manipulation?

Look for someone who:

  • Is willing to coordinate treatment with your other health care providers
  • Will tell you about home treatment and exercises.
  • Diagnoses problems with a physical exam and an interview, using X-ray in unusual cases.
  • Is willing to refer you to a specialist when needed. This may include an orthopedist, neurosurgeon, or oncologist for further testing, or a registered dietitian for nutritional counseling.

Avoid someone who:

  • Uses X-rays as a standard diagnostic test, especially full-body X-rays or X-rays of children. These give unnecessarily high levels of radiation.
  • Uses manipulation to treat such problems as lung and ear infections, skin conditions, eye problems, and learning disabilities.
  • Promotes regular manipulation as a way to prevent illness or joint problems.

What are the risks of spinal manipulation?

Slow pressing movement, sometimes called mobilization, has no known risks.

Certain symptoms, such as sharp pain or low back pain with leg pain or numbness, can be a sign of a serious condition that needs medical treatment right away. If you have these symptoms, spinal manipulation may not be the right treatment for you.

If manipulation leads to more pain, new pain, or numbness in the legs or anywhere else, stop the treatment.

When might you consider spinal manipulation?

  • Your symptoms aren't caused by any serious conditions.
  • You have tried home treatments for a few weeks, and your back pain is not better.
  • You want to avoid using medication.
  • You have tried manipulation in the past and have been satisfied.

2. Compare your options

  Have spinal manipulation Use other treatment
What is usually involved?
  • You lie on a special table while the practitioner puts pressure on your head, shoulders, back, or hips. The treatment can range from slow pressing to a quick thrust.
  • You can apply ice or heat to your back, find a comfortable position when you rest, and exercise regularly.
  • You can take pain medicine.
What are the benefits?
  • Some people get pain relief.
  • For most people, home treatments relieve low back pain within 4 to 6 weeks.
What are the risks and side effects?
  • Slow pressing has no known risks.
  • Although it is very rare, forceful or rapid movements, especially to the neck, may cause problems. Manipulation is not recommended for people who have nerve-related problems that are very severe or getting worse. 2, 1
  • Some people keep having back pain even with home treatment.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about spinal manipulation for low back pain

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I grew up in a family that swears by spinal manipulation. When I moved out on my own in another city, I went to the chiropractor down the street from me when I hurt my back. I didn't feel comfortable. This guy was totally different from my old chiropractor—he wanted to use some treatments that have nothing to do with my spine. I talked to some friends and to my doctor and found a good chiropractor that way."

— Tara, age 24

"I've put up with bouts of this back pain over the years, but this time I couldn't walk right. After a couple of days, a friend of mine suggested I see his osteopathic doctor to have my spine worked on. I didn't know much about spinal manipulation, but I thought I'd give it a try. And you know, after just one visit, my pain got a lot better."

— Joe, age 40

"I'm pretty careful about who I choose for my medical care. So I did some research before going to see someone about treating my back pain. I'd heard about some people who actually felt worse after spinal manipulation. I'd also heard from friends that manipulation helped them a lot. So I talked to my doctor and got the names of a physical therapist and a chiropractor. I talked to each of them on the phone ahead of time about how they practice. They both sounded great. After I made sure that both were covered by my health insurance, it was a toss-up. I took the first appointment that was available. A few appointments and daily exercises at home have brought me such relief!"

— Sandra, age 37

"I hurt my back from using a posthole digger, and I also had pain in the back of my thigh. I went to the guy who worked on my friend's back, and he had me get an X-ray and gave me a spinal adjustment. After a week of seeing him, I began having pain farther down my leg, into my calf. I went to my family doctor and eventually I had a test called an MRI. It showed that I had a herniated disc. I'll hold off on manipulation and try some other treatments for now."

— Dave, age 55

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose spinal manipulation

Reasons not to choose spinal manipulation

I am comfortable with treatment that involves hands-on contact.

I don't like the idea of treatments that involve physical contact.

More important
Equally important
More important

I want to avoid using medication for my pain.

Medication or another treatment will help relieve my pain.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Trying spinal manipulation

NOT trying spinal manipulation

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Do most people with low back pain get better with home treatment?

  • Yes
  • No
  • I'm not sure
That's right. For most people, home treatments—such as ice, moist heat, pain relievers, and mild exercise—relieve low back pain within 4 to 6 weeks.

2. Is spinal manipulation a back pain treatment that works for everyone?

  • Yes
  • No
  • I'm not sure
Correct. This treatment works for some people but not others.

3. Should you stop treatment right away if a spinal manipulation makes your pain worse or causes new pain in your legs or anywhere else?

  • Yes
  • No
  • I'm not sure
You're right. Sharp pain or low back pain with leg pain or numbness can be signs of a serious condition that needs medical treatment right away.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics
References
Citations
  1. McIntosh G, Hall H (2011). Low back pain (acute), search date December 2009. Online version of BMJ Clinical Evidence : http://www.clinicalevidence.com.
  2. Binder A (2008). Neck pain, search date May 2007. Online version of BMJ Clinical Evidence : http://www.clinicalevidence.com.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Revised: November 19, 2012

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Robert B. Keller, MD - Orthopedics

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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