How Spinal Manipulative Therapy Works: Why Ask Why?

For some patients, spinal manipulative therapy is an effective treatment for spine pain, yet we really don't fully understand how or why. The mechanisms of spinal manipulative therapy are not well defined, and common explanations for why spinal manipulative therapy works lack supporting evidence. Traditionally, the decision to incorporate spinal manipulative therapy into a plan of care is based on a seductively plausible biomechanical theory. Examination techniques, sometimes quite elaborate in nature, are used to determine painful structures and associated abnormalities related to alignment and mobility. The appropriately matched spinal manipulative therapy treatment techniques are then implemented to correct “pathological” findings. The underlying implication of these approacheds is that success of spinal manipulative therapy is dependent upon correction of biomechanical faults detected on examination. J Orthop Sports Phys Ther. 2008;38(6):293–295. doi:10.2519/jospt.2008.0118