Spinal Manipulation: Benefits Vs Risks

‘Spinal Manipulation’ (also known as ‘bone cracking’) is the forced passive flexion, extension, and rotation of vertebral segments, moving joints beyond the usual range of movement to the limit of normal anatomic range.

Spinal manipulation may be used effectively in  for the treatment neck and back pain by chiropractor, osteopathy and physiotherapists.

There are limited evidence on effectiveness long term treatment with spinal manipulations for whiplash with neck pain, although in short terms it helps to relieve pain, increase flexibility, ‘feel good’ temporarily. Also rarely, potential serious side effects may happen include: vertebrobasilar accidents (VBA), strokes, death, spinal disc herniation, rib fractures.

Edzard Ernst has written:

“…there is little evidence to demonstrate that spinal manipulation has any specific therapeutic effects. On the other hand, there is convincing evidence to show that it is associated with frequent, mild adverse effects as well as with serious complications of unknown incidence. Therefore, it seems debatable whether the benefits of spinal manipulation outweigh its risks. Specific risk factors for vascular accidents related to spinal manipulation have not been identified, which means that any patient may be at risk, particularly those below 45 years of age. Definitive, prospective studies that can overcome the limitations of previous investigations are now a matter of urgency. Until they are available, clinicians might tell their patients to adopt a cautious approach and avoid the type of spinal manipulation for which the risk seems greatest: forceful manipulation of the upper spine with a rotational element

News report on chiropractor spinal manipulation:

It is important to seek a professional physiotherapist to assess the need for a spinal manipulation, as there are many alternative treatment approaches that may be more effective.

To find out alternative pain treatments, please speak to our physiotherapists: 64388725


Spinal manipulation: Its safety is uncertain. Edzard Ernst, CMAJ, January 8, 2002; 166 (1)

^ Martín Saborido C, García Lizana F, Alcázar Alcázar R, Sarría-Santamera A (May 2007). “[Effectiveness of spinal manipulation in treating whiplash injuries"] (in Spanish; Castilian). Aten Primaria 39 (5): 241–6. PMID 17493449.


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