Low back pain: Should I have spinal manipulation?

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, this is not a decision you should make right now. See your doctor.

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 that could be made worse by spinal manipulation.
Spinal manipulation doesn't work any better for low back pain than medicines and physical therapy.
Spinal manipulation works for some people, but not for others.
You can't count on spinal manipulation alone. You will 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 or twisting to rapid movement or forceful pressure.

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:

Find out ahead of time whether your health insurance will cover treatment by the person you've chosen. And make sure that the person is willing to coordinate care with your other health professionals, like your doctor or physical therapist.

How well does spinal manipulation work for low back pain?

Spinal manipulation helps relieve short-term low back pain for some people. It doesn't work for everyone.

Most studies that compare this treatment with others show that spinal manipulation is no better than physical therapy or exercise.^1, ²

People who feel better after spinal manipulation usually do so after just one visit, and more visits may not be needed.³

At most, 2 to 3 weeks of this treatment is considered to be enough for acute low back pain. "Acute" means that your pain lasts less than 3 months. Back pain is called "chronic" if it bothers you most of the time for longer than 3 months.

Some practitioners encourage long-term treatment to prevent future problems. But there's no proof that this does any good.

After you have had your spine manipulated, you will still need to learn how to take care of your back. And you can learn how to strengthen your muscles so that they better support your spine.

How do you choose someone to do spinal manipulation?

How well this treatment works depends partly on the person's skill. Ask your medical doctor to help you find someone. Interview one or two before you start treatment.

Look for someone who:

Is willing to coordinate treatmentwith your doctor or other health care workers.
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.
Uses slow, gentle manual techniques.

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.
Bases his or her practice on the unproven theory that subluxation (partial dislocation of two joint surfaces) causes many diseases.
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 or twisting, sometimes called mobilizing movement, has no known risks. But forceful neck movements, as performed by some practitioners, have been linked to rare but serious cases of nerve damage and sometimes death.

Rapid neck movement can injure blood vessels along your spine. This can lead to a stroke. It can also cause disc herniation that can lead to nerve or spinal cord damage.

You can avoid this type of risk by seeing someone who uses slow, gentle techniques to treat carefully diagnosed conditions. Talk to your doctor or physical therapist before you try any treatment for your neck.

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. Manipulation could make things worse.

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

Why might your doctor agree with your decision to try spinal manipulation?

Your doctor might agree if:

Your symptoms aren't caused by any serious conditions that could be made worse by manipulation.
You have tried home treatments for at least 6 weeks, and your back pain is not better.
You have tried manipulation in the past and have been satisfied.

2. Compare Options

	Have spinal manipulation	Use other treatment
What is usually involved?	You lie on a special table while the practitioner pushes, twists, or presses on your head, shoulders, back, or hips.	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 or twisting has no known risks. Although it is rare, forceful or rapid adjustments, especially to the neck, have been linked to serious problems and sometimes death.	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.

If you need more information, see the topic Low Back Pain.

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 chiropractic care. 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 was shocked. This guy was totally different from my old chiropractor—he was pushy and wanted to use all kinds of costly treatments that have nothing to do with manipulating my spine. I asked around for a chiropractor with a good reputation and found a good one 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 adjusted. 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 some troubling stories about chiropractors who have hurt people or said they could treat disease that they couldn't, but then there are medical doctors out there who fit the same description! I'd also heard from friends that their chiropractic care 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. But it turns out my insurance will help pay for physical therapy, so I made an appointment with the physical therapist. I've been really happy with her and the back pain relief I've had after a few spinal adjustments and daily exercises at home. "

— Sandra, age 37

"I hurt my back from using a posthole digger, and I also had pain running down my leg. 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 appointments, I realized that my leg was getting a little numb, so I called my family doctor. It turns out that I had a herniated disc and should have gone to my doctor first. "

— Dave, age 55

3. Your Feelings

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 feel confident that I can find a practitioner with a good reputation.

I am worried about finding a good practitioner.

More important

Equally important

More important

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'm not worried about the risks of spinal manipulation, because I know they are rare.

Even though side effects are rare, I still worry that they could happen to me.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

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. Quiz Yourself

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. A spinal manipulation could make things worse.

Decide what's next

1. Do you understand the options available to you?

Yes
No

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

Yes
No

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

Yes
No

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.