Injury type: Acute/ Chronic

Category: Allied Health Options

Rating: No Research

What is it?

Technically, manipulation is defined as a localised force of high velocity and low amplitude thrust directed at a spinal joint. Manipulation is also known as ‘adjustment’ or ‘cracking’. It involves a qualified professional (i.e. chiropractor, physiotherapist) positioning your body and then applying a small, fast movement, resulting commonly in a cracking sound in a spinal joint. The force may be applied with the therapists hands or using a tool or piece of equipment. It is different from soft tissue manipulation/massage and mobilization, both of which are covered in separate pages on this site.

How does it work?

It is thought that manipulation of a spinal joint may provide a temporary increase in joint range of movement by acting on the soft tissues around the joint itself. It may also correct spinal alignment and give relief from musculoskeletal pain. Manipulation may also have physiological effect on the nervous system and provide pain relief via this means.

Is it effective?

The evidence for manipulation for whiplash is inconsistent. A systematic review of existing whiplash guidelines1 found that passive joint manipulation was recommended across all guidelines. However, a rapid review2 synthesising evidence from highest level of primary studies, systematic reviews, and well-conducted clinical practice guidelines identified that manipulation is not recommended. An update systematic review3 concluded that there is ‘not enough or inconsistent evidence to make determination’ regarding the use of manipulation for recent and persistent grades I-II whiplash.

On the other hand, evidence on the use of manipulation for neck pain in general has been more widely researched. Overall, the evidence suggests that manipulation seems to be most effective for pain relief and function improvement when it is used in conjunction with other treatments (i.e. as a multimodal treatment), such as exercise. This evidence comes from a review4 synthesising findings from three systematic reviews on acute and chronic neck pain, and a recently published systematic review and meta-analysis5 on chronic non-specific neck pain.

Are there any disadvantages?

Some of the disadvantages of manipulation may be local discomfort, increased neck pain, headache, thoracic pain, altered sensation, dizziness, tiredness, or radiating discomfort. Infrequent, but potentially serious side effects, may include: vertebrobasilar accidents (VBA)[1], strokes, spinal disc herniation, vertebral and rib fractures, and cauda equina syndrome. Therefore appropriate assessment and tests should be carried out by the therapist prior to manipulation.

[1] A vertebrobasilar accident results in verterbrobasilar insufficiency, which is an obstruction or blockage of an important group of blood vessels called vertebral-basilar system. Blockage of these blood vessels result in problems with consciousness, headache, dizziness, paralysis of legs and/or arms, difficulty speaking and paralysis of face muscles.

Where do you get it?

Spinal manipulation (including the neck) must be provided only by qualified professionals such as chiropractors, physiotherapists, osteopaths and doctors.


The use of manipulation following whiplash cannot be recommended due to a lack of current research evidence. More research is required.