, Gloucester, MA

February 15, 2013

What's the pop and should it hurt?

Spinal manipulation questions answered

On the Mend
Joe DiVincenzo

---- — Spinal manipulation has been one of the most widely utilized and popular forms of therapy for patients with neck or back pain.

Commonly applied by bone setters, the first documented use of manipulation predates the Greek philosopher Socrates in 470 B.C. making it the oldest form of manual therapy in recorded history. In modern times, we call these clinicians physical therapists and chiropractors, and they use spinal manipulative techniques regularly to mitigate spinal problems.

Spine pain is akin to the human experience just as much as death, taxes or any other commonality shared by everyone in the world. While unpleasant, there’s nearly a 100 percent chance it will happen to you, significantly, at one point in time.

Our treatment techniques, decision algorithms and research methods have dramatically improved our ability to deliver spinal manipulation to patients — especially so in the last decade.

Here are some of the most commonly asked questions regarding spinal manipulation techniques. If you’re still curious, speak with a trusted physical therapist or chiropractor to see if you’re a candidate for treatment.

Can spinal manipulation help pain that radiates into my arms and legs? Nearly all cases of referred pain into the extremities respond well to manipulation. By itself, it is generally not enough of a modality to keep pain away for good, so expect some other interventions at your appointment.

Do adjustments hurt? Most adjustments are painless. There are some that can be mildly uncomfortable, but that should only last for a second or two.

Is it common to be sore later on in the day? Absolutely. Spinal manipulative therapy moves and stretches the spine — sometimes in dramatic fashion. Consider it the pain of accommodating to proper alignment.

Can joints really be out of alignment? There’s no research study or any other empirical evidence to suggest that a bone is out of place — or that we’re putting it back with treatment. All we know is that patients who seek treatment because their back feels “out of whack” often leave feeling “straightened out.”

Does the spine have to pop or crack in order to have a benefit? Research suggests that the sound isn’t necessary to achieve a desirable outcome, but the author of this column believes that the popping phenomenon is an important and necessary part of an optimal treatment.

Do people sustain injuries during adjustment therapy? Injuries to the lumbar spinal disc are estimated to occur in about one in 4 million manipulations. Injuries to the neck occur much less frequently than that — one occurrence in every 60 million manipulations.

If I have low bone density, should I have a manipulation? Bone density is an area specific problem more associated with post-menopausal women than with men of any age. However, because things such as low testosterone, kidney or thyroid problems are so commonplace, it’s recommended that all patients have a full medical screen and profile taken before engaging in any kind of repeated adjustment therapy.

Gloucester resident Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He writes “On the Mend” weekly. Questions may be submitted by email to