Spinal Manipulation for Low Back Pain

Low-back pain is a common condition that can be difficult to treat. Spinal manipulation is among the treatment options used by people with low-back pain to relieve pain and improve functioning. The procedures are most commonly performed by chiropractors. This fact sheet summarizes the current scientific knowledge about the effects of spinal manipulation on low-back pain.

Key Points

  • Evidence indicates that spinal manipulation can provide relief from low-back pain. It appears to be as effective as conventional treatments, and recent international guidelines for health care practitioners include it as a treatment option for back pain.
  • Spinal manipulation is generally a safe treatment. The most common side effects (e.g., discomfort in the treated area) are minor and generally go away within 1 to 2 days. Serious complications are very rare.
  • Recent research into spinal manipulation for low-back pain has begun to look at the effects of different forms of manipulation, as well as treatment duration and frequency.

About Low-Back Pain

Each year, up to one-quarter of U.S. adults experience low-back pain. Most people have significant back pain at least once in their lives; often, the cause is unknown. Back pain varies widely. For many people, it lasts only a few weeks. But for others, the pain can become chronic and even debilitating. Low-back pain is a challenging condition to diagnose, treat, and study.

Spinal Manipulation and Low-Back Pain

Spinal manipulation—sometimes called “spinal manipulative therapy”—is practiced most commonly by chiropractors. Practitioners perform spinal manipulation by using their hands or a device to apply a controlled force to a joint of the spine, moving it beyond its passive range of motion. The amount of force applied depends on the form of manipulation used. The goal of the treatment is to relieve pain and improve physical functioning.

Chiropractic is a health care approach that focuses on the relationship between the body’s structure—mainly the spine—and its functioning. In chiropractic, spinal manipulation is sometimes called “adjustment.” Pain related to the back, neck and headaches are the most common reasons people seek chiropractic care.

What the Science Says

Study Findings to Date

Overall, studies have shown that spinal manipulation can provide relief from back pain and appears to be as effective as conventional medical treatments. In 2007 guidelines, the American College of Physicians and the American Pain Society include spinal manipulation as one of several treatment options for practitioners to consider using for back pain.

Recent studies have found that spinal manipulation provides relief from low-back pain, and that pain-relieving effects may continue for up to 1 year. In one study funded by the National Center for Complementary and Alternative Medicine (NCCAM) that examines long-term effects in more than 600 people with low-back pain, results to date suggest that chiropractic care involving spinal manipulation is at least as effective as conventional medical care for up to 18 months.

Side Effects and Risks

Common Side Effects

Reviews have concluded that spinal manipulation is relatively safe when performed by a trained and licensed practitioner. The most common side effects are generally minor and include temporary discomfort in the treated area, headache, or tiredness. These effects usually go away in 1 to 2 days.

Serious Complications

The best evidence suggests that chiropractic care is a useful therapy for subjects with neck or low-back pain for which the risks of serious adverse events should be considered negligible. Although rare, potential complications from manipulation to the spine include fracture, herniated disc, stroke and cauda equina sydrome.

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