Physical Therapy and Spinal Manipulation-Can it Help Me?

Physical Therapy and Spinal Manipulation - Can it help me?

Most major guidelines on the treatment of low back and neck pain include spinal manipulation as part of a comprehensive treatment plan 1,2,3,4.  A recent “Consumer Reports” report also included spinal manipulation as an option for treating low back pain5.   This short article will help you better understand what spinal manipulation is, how it works, and how it fits into physical therapy.

What is spinal manipulation?

Manipulation has been defined as “A manual therapy technique comprising a continuum of skilled passive movements to the joints and/or related soft tissue that are applied at varying speeds and amplitudes, including a small-amplitude/ high- velocity therapeutic movement.” 6

The manipulation technique utilized in physical therapy is a hands on technique that uses a high velocity (fast) low amplitude (small amount of movement) thrust to the joint that is being treated. To deliver the high velocity low amplitude thrust your therapist will  us his or her hands to position the joint to be treated to a point where a gentle thrust can be delivered.   The goal of manipulation is to increase mobility, decrease pain, and improve function.

Spinal manipulation is only utilized after a thorough examination, observing functional movements and manually (with our hands) assessing the mobility of the joints of the spine. If based on all of this information spinal mobilization is indicated and appropriate for your condition we then perform the indicated techniques.

Manipulative techniques can be applied to the cervical spine (neck), thoracic spine (mid-back), and lumbar spine (low back). These types of techniques can also be applied to other joints and conditions (such as shoulder or hip pain) as well.

How does spinal manipulation work?

There are 2 main theories on how spinal manipulation works:

1 - A mechanical effect: By delivering the thrust to a joint that is stiff or not moving as well as it should, we can help improve the mobility of that joint through manipulation and should observe improved range of motion and overall mobility. 7

2- A neurophysiologic effect: When the force of a manipulation is delivered to the joint the nerves around the joint and receptors of the connective tissue and muscles around the joint are stimulated. This quick stimulation to these nerves and receptors relaxes stiff muscles, decreases pain, and can improve muscle function for better control of the joint 8.

A manipulation to a joint is only one part of an overall treatment plan. Through manipulation we should be able to observe an improvement in motion, decreased pain, and better function. At Performance Physical Therapy & Sports Conditioning utilize a test-treat-retest approach. This means we will test a painful or limited range of motion then perform a manipulative technique and re-test that position, motion or activity to observe if there was an improvement in motion, pain, or function.

We almost always follow manipulation techniques with exercises that reinforce the mechanical and neurophysiologic (nerve) effects of the manipulation. Other manual techniques such as massage, soft tissue work, range of motion, and mobilization may also be utilized as part of a comprehensive treatment program.

If you have questions about spinal or joint manipulation or mobilization and how it can help you reach your goals of improved mobility, less pain, and better function give us a call today!

About the Author: Anthony Falco, PT, DPT, OCS, CSCS is a leading physical therapist in the treatment of back and neck pain. He is an is an APTA Board Certified Orthopedic Clinical Specialist (OCS), making Anthony one of the top 1% of all practitioners in the state. To book and appointment with Anthony please call 973.835.2827, reach out to us on social media, email or visit our 2025 Hamburg Turnpike location. 


  1. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T,
    Kraegel P, Griffin J, Grusing S, Brodt ED. Nonpharmacologic Therapies for Low
    Back Pain: A Systematic Review for an American College of Physicians Clinical
    Practice Guideline. Ann Intern Med. 2017 Apr 4;166(7):493-505.
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    TR, Godges JJ; Orthopaedic Section of the American Physical Therapy Association.
    Low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):A1-57.
  3. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C,
    Robertson EK. Neck Pain: Revision 2017. J Orthop Sports Phys Ther. 2017
  4. National Collaborating Centre for Primary Care (UK). Low Back Pain: Early
    Management of Persistent Non-specific Low Back Pain [Internet]. London: Royal
    College of General Practitioners (UK); 2009 May.
  5. Consumer Reports Articles:
  6. Guide to Physical Therapist Practice
  7. Cross KM, Kuenze C, Grindstaff TL, Hertel J. Thoracic spine thrust
    manipulation improves pain, range of motion, and self-reported function in
    patients with mechanical neck pain: a systematic review. J Orthop Sports Phys
    2011 Sep;41(9):633-42.
  8. Pickar JG. Neurophysiological effects of spinal manipulation. Spine J. 2002
    Sep-Oct;2(5):357-71. Review.

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