Spinal Manipulation

Physiotherapists at Core Body Clinic are experts in the delivery of Spinal manipulation.  It is very useful for lower back pain, mid back pain and neck pain and is similar to that used by Chiropractors and Osteopaths.  It can also be used to treat shoulder pain by improving the dynamics of the thorax and rib cage.  


It is characterised by a sudden and sharp movement performed by the physiotherapist and is often associated with an audible 'click' or 'popping' sound.  It is almost always accompanied by pain relief.

The physiotherapists at Core Body Clinic are highly trained in the art of Spinal Manipulation having undergone post graduate training and 1000s hours of supervised clinical practice and application.  Adrian Wagstaff is the Lead physio at Core Body Clinic and is also a teacher of Spinal manipulation.  He teaches Masters students the theory and practice of spinal manual therapy, travelling both nationally and internationally.

How Does it work?

The likely benefit from spinal manipulation is pain relief via the release of neuro-endorphins and nor-adrenaline.  It has long been theorised to  mechanically correct bony mal-alignments or subluxations of the spine and there is speculation that it may reduce and break down scar tissue formed after injury.  However, there is no credible evidence that the technique does this.  In fact the force used to deliver the manipulation is of a 'low amplitude' and therefore does not carry the necessary energy to change tissue status.  A study by Cramer et al.(2000) demonstrated such little change in joint space after spinal manipulation, with some patients actually having less space between joint surfaces in the spine than prior to manipulation.  Therefore, there is no credilble evidence that we can 'click' the spine back into place and because our spinal discs are so incredibly strong it is unlikley to resolve slipped discs.  Spinal disc take time to deform and if we could slip them back in they would merely slip back out.  Again, there is no evidence it can change the pressure within the disc.  If a therapist elects to use the technique on a patient with disc pain and sciatica there may be some change in pain but to what extent this is movement of the disc is largely debateable and carries no scientific evidence.  Furthermore, there is no evidence that this technique is safe in the treamtment of nerve pain.  Careful assessment must be completed prior to application. 

Spinal manipulation has been shown to alter muscle function and can have a therapeutic effect on muscle spasm via spinal reflexes.  At the same time it can be used to enhance muscle performance making it highly beneficial during therapy sessions where rehab gains are required.  However, any effects are very short lived and while enabling patients to move pain free, must be accompanied with exercise to have a lasting effect.  

Interestingly, we cant always tell which joint has been manipulated.  While we aim to target a specific joint it is not possible to isolate one joint, the research tells us.  Because of this we are unable to 'adjust' the spine with any specificity,  

What is the 'Popping' sound?

To achieve a manipulative thrust a combination of movements are used to manouvere the selected joint into a ‘mid-range’ position.  In this posture the therapist then performs a low amplitude movement delivered at high velocity.  The sudden movement causes the formation of bubbles inside the joint synovial fluid and a ‘popping’ or ‘cracking’ is heard, thought to be either gas escaping from the target joint or from friction between the soft-tissues around the spine.    

How Does it feel?

The treatment is designed to alleviate pain.  May people experience immediate and lasting pain relief after spinal manipulation  It should feel comfortable because the joint is placed in 'mid-range' and therefore not stretched. The Physiotherapists at Core Body Clinic are experts at performing manipulation.  After the manipulaiton is performed the patient often experiences less pain and improved movement.  There should be little discomfort during the procedure although some patients have experienced soreness lasting less than a few hours and no more than a few days.  Patients are advised to exercise after and should continue the exercises unless instructed otherwise.  

Studies do show that anticipation can affect the outcome.  Therefore, if we tell patients of the positve outcome then it is likely to feel better.  Conversaly, if a patient thinks that the technique and sound has done them harm then they are likely to experience pain. 

Will it help My condition?

Spinal Manipulation can be used on a number of conditions.  At Core Body Clinic we have found it useful on a number of common conditions:

Is it Safe?

With the exception of manipulations performed on the cervical spine, manipulations are very safe.  At Core Body Clinic our physiotherapists follow strict criteria to ensure that treatment selections are appropriate for a specific patient and their problem.  

Who else performs Manipulations?

The first manipulations performed were by bone setters in the time of Hippocrates (400BC) and since then the therapy has been taken up by Physiotherapists, Osteopaths, Chiropractors and some medical practitioners.  


The NICE guidelines and a recent Cochrane review support it as an effective treatment for spinal pain.  However, it must be used as part of a treatment package to be helpful for back pain.  

Bialosky JE, Bishop MD, Price DD, Robinson ER, George SZ (2009) The Mechanisms of  Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model. Manual Therapy.  14 (5) 531-538

Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder W(2013) ‘Spinal manipulative therapy for acute low back pain: an update of the cochrane review’.  Spine (Phila Pa 1976). 1;38(3):E158-77. doi: 10.1097/BRS.0b013e31827dd89d.

Cleland, J.A., Fritz, J.M., Whitman, J.M., Childs, J.D., Palmer, J.A. (2006) ‘The use of a lumbar spine manipulation technique by physical therapists ipatients who satisfy a clinical prediction rule: a case series.  Journal of Orthopaedic Sports physical therapy. (36), 209-214

Evans, D.W., Breen, A.C. (2006) ‘A biomechanical model for mechanically efficient  cavitation production during spinal manipulation: Prethrust position and the neutral zone.  Journal of Manipulative and Physiological therapeutics. 1 (29) 72-82

Cramer, G.D., Tuck, N.R., Knudsen, J.T., Fonda, S.D., Schliesser, J.S., Fournier, J.T., (2000) ‘Effects of side-posture positioning and side posture adjusting on the lumbar  zygapophysial joints as evaluated by magnetic resonance imaging: a before and after study with  randomization’. Journal of Manipulative and Physiological Therapeutics.23, 380- 94.

Dunning, J., Rushton A. (2009) ‘The effects of cervical high-velocity low-amplitude thrust manipulation onresting electromyographic activity of the biceps brachii muscle’ Manual  Therapy. 14, 508-513

Pikar, J.G (2002) ‘Neurophysiological effects of spinal manipulation.’ The Spine journal. (2), 357-371