Spinal manipulation: where, how and why?

Spinal Manipulation Therapy is nothing more than a decisive and dry micromovement that involves a segment of the spine.

The sudden stretching of the muscles surrounding the vertebrae, the disc and the vertebral joints is the objective that this type of treatment poses and that the operator tries to perform with safety and professionalism.

In general, in fact, this treatment must be carried out by an experienced professional, who possibly graduates in medicine or physiotherapy.

Column manipulation: when to use it?

Spinal manipulation is usually used in the case of painful symptomatology in the spine. In particular:

  • Lumbago;
  • Cruralgie and sciatalgie of pectoral and lumbar origin;
  • Dorsalgie of cervical, thoracic origin, of cost-vertebral origin or related to the cost;
  • Cervicalgie and cervical-brachialgia, for the cervical origin;

Spinal manipulation: objectives and characteristics

The spinal manipulation is characterized by the snap joints. Let me explain better, this maneuver at the time of execution is followed by a small joint shake like the sound of breaking a rigid object.

This spontaneous noise of the treated vertebrae is caused by a cavitation process within which a sudden decrease in gas pressure is released from the synovial flow in the joint cavity, generating the typical noise of the “bubble burst”.

It is precisely the stretching of these anatomical structures that intervenes in the causes of pain and determines the muscular deconstruction necessary to restore the mobility of the spine, as well as the well-being of the patient.

Crunch, denigrated by many as considered detrimental and tired by joints, does not really seem to cause the imagined damage since these claims have never been supported by empirical evidence.

Management as a therapeutic gesture

Therefore, it is possible to call spinal manipulation a true medical and physiotherapeutic therapeutic gesture.

For this reason, the actual need of the patient to be treated through it is usually defined beforehand.

Various control tests are, in fact, the necessary tools to achieve the patient’s well-being.

Only a complete medical examination of the patient will allow, in fact, to determine if the spinal manipulation can benefit the health or aggravate it even more.

In addition, through a complete and detailed examination , you can also delineate the patient’s profile, which allows you to choose the type of maneuvers you want to perform as well as their frequency.

This type of diagnosis will also allow you to achieve a remarkable therapeutic impact, thus monitoring the results of the therapies: sometimes the pains may be of a different origin than what is believed.

The doctor can exclude or identify the veracity of the problem through the medical history, the collection of patient data and the requirement of new investigations. The physiotherapist can manipulate and establish an adequate treatment, but only in the presence of a medical diagnosis.

This exam is structured through three phases:

  • General diagnosis;
  • Indication of manipulative therapy;
  • Determine the type of manipulation that must be done;

Once the operator has become aware of the problems and solutions that must be taken into account to bring well-being to the patient, manipulation of the spine can be performed both by the physician and the physical therapist (in the presence of medical diagnosis).

Spinal manipulation step by step

This passive movement is carried out through:

1. U ocation patient

Depending on the position that the patient must adopt correctly, the operator must assume an appropriate position in such a way as to carry out the manipulation in the best possible way, without causing harm to the patient.

2. Live

In general, the segment to be treated is immobilized by the operator until it finds the end of the passive movement in which it is necessary to insist.

3. Handling impulse  or proper handling.

After choosing the direction and position the voltage is started by a short pulse, a fast and limited movement that has received a resistance from the joint and is accompanied by the characteristic burst.

Only overcome this resistance, the movement, however, must be terminated immediately because, otherwise, it can determine the dislocation of the joint.


Depending on the execution technique, the manipulations can be classified as:

1. direct manipulation , performed by direct pressure made on the vertebral or transverse spine bones;

2. Indirect manipulations , carried out through the establishment of natural lever arms. These arms are formed from the head, shoulders, pelvis and extremities through which it is possible to move the spine;

3. Semi-indirect manipulations through which the operator also uses a point of support in the spine, as well as the lever arm;

The semi-indirect manipulations are divided according to the thrust that is made while the backrest is in the opposite direction.

In general, they are divided into:

  • assisted , the most powerful manipulations as it adds to the thrust of the lever arm;
  • Contrariety, restrict the main movement and allows to protect against a movement does not want the previous column tract and below the level at which the maneuver takes place.

Spinal manipulation and pain

The spinal manipulation performed by the physician or physical therapist should not be painful, as well as the manipulative act itself.

Manipulative treatment may require more than one session (usually 3-4) but, in some cases, even a single session can solve the problem.

If the maneuver was painful for the patient, it should be done in the opposite direction.

If the maneuver is not feasible also in this case, it will be an important signal for the doctor or physiotherapist.

Damage after a small manipulation, in fact, is a lot and even a serious nature.

Vertebral collapses and coastal fractures are unpleasant but spontaneous events.

Spinal manipulation between benefits and contraindications

Vertebral manipulations are very effective therapies, especially for the treatment of benign pain of vertebral origin.

According to publications and evidence of scientific origin, it was possible to determine the positive effects of vertebral manipulations.

In general, the benefits are:

  • The reduction of painful symptoms;
  • Release of local muscle tension through inhibition of the peripheral nervous system;

E ‘for the positive effects that health care specialists can use these techniques in such a way that it generates factors that can facilitate the healing of back ailments.But there are as many benefits as contraindications.The spinal manipulation, in fact , it is not recommended to those affected by:

  • Primary or secondary neoplastic diseases
  • Rheumatic diseases;
  • Acute or chronic infectious diseases such as arthritis;
  • Recent traumatic diseases such as fractures and / or distortions;
  • Juvenile osteochondrosis.

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