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Why Have You Been Seeing Your Manual Therapist For So Long? The Truth About Spinal Manipulation


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Was manipulation care your first thought when you hurt your back? It should have been. But what does it really do?

Manipulation is a specialty health treatment based on the idea that the central nervous system (brain and spinal cord) controls all functions in the body. The role of the Physiotherapist, Chiropractor or Osteopath (manual therapist) is to find and remove any interference in the nervous system caused by spinal misalignment-scientifically termed “subluxation. " By correcting subluxations, your manual therapist allows your body's natural healing ability to perform as it should.

After all, even if they employed even a small fraction of what they know, it should have been enough to bring you relief. Right?

Manual therapists use hot and cold packs, ultrasound, electrical stimulation, and all sorts of hand held mechanical devices for vibration and direct pressure. Then there are X-rays and a variety of manual techniques. All of these are very good at preparing the body for the chiropractor's main goal: correcting spinal misalignment.

Manipulating or Cracking the back, neck, hips, or virtually any joint has been and always will be the bread and butter of the manual therapist - and for good reason. It takes a lot of education, experience and a lot of skill to do it well. But is cracking the back the answer to the most people's back problems?

It is true that spinal misalignment is most likely the primary cause of your pain and is, in fact, responsible for almost all forms of back pain. It is also true that correcting that misalignment is a critical step on the road to relief. But is correcting the misalignment through spinal manipulation (cracking the back) enough?

If you ask me, I would have to say no. One of our customers said it best: “Bones only go where our muscles pull them. " The main reason clients continue to see their manual therapist for so long is that cracking the back feels good. And it does bring temporarily relief.

But when little or no effort is put into correcting the muscle imbalances that are causing the pain, it's a foregone conclusion that the misalignment will eventually return along with the discomfort. Let's take a closer look at muscle imbalances.

Our muscles hold our bones and joints in place. They provide stability and locomotion for us. Therefore, it is critical that the very delicate balance between all muscle groups be in balance and stay in balance in order for us to live and active and pain free life.

Even more so if you're an athlete - the more your muscles are in balance, the better the athlete you will be. Our bodies adapt to the forces and stress we place on them.

It takes months, if not years, to develop muscle imbalances that can cause spinal misalignment. You must understand that your condition - whatever it may be - took time to develop. It probably was not due to a single event, even though you may have experienced pain after you think you “overdid it" - whatever the “it" might be.

As I noted, muscles hold joints and bones in their place and, over time, your muscles can get out of balance. Those imbalances can develop into postural dysfunctions and spinal misalignment, forcing the pelvis to shift into an abnormal position. When this happens, your spine will be forced into an abnormal curvature and held there for years.

I hope you are starting to see the big picture. Failure to address these imbalances as part of your recovery program will ensure continued suffering.

This brings me back to why I believe manipulation care has failed so many of you. It's foolish to expect that simply manipulating your back-one little “crack" or “pop" - is going to correct the muscle imbalances, postural dysfunction, and spinal misalignment that I described above.

For manipulation care to be at its best, the practitioner must draw on all his or her knowledge, experience and skill when treating a patient, which can be tough to do in 15 minutes or less. So if your manual therapist is not addressing your muscle imbalances along with cracking your back, do not expect to get lasting relief.

Arjen Bootsma is a Physiotherapist and Medico-legal Expert Witness who has a highly successful Clinic (ChesterPhysio) in the UK, please visit for more details. He also looks after the National Welsh Gymnastic Squad and is an authority in the field of Spinal Disorders. If back pain or sciatica is controlling your life then please visit or just simply send an email to for any help you need.


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