Chiropractors and other practitioners use a technique called spinal manipulation in the treatment of neck pain, upper back pain, and lower back pain, in cases of headaches, for the improvement of shoulder function, and more. Here we will take a deeper look into the “nuts and bolts” of the technique and how we use it to help our patients.

 Spinal manipulative therapy (SMT), often referred to as a chiropractic adjustment or manipulation, is a specific and skilled application of force to the joint segments of the thoracic, lumbar, or cervical spine with the intent of pain reduction and restoring range of motion1. These adjustments are used on specific types of joints called synovial joints, which are joints throughout the body that contain a joint cavity. Within this joint cavity, there is a layer of tissue called the synovium which secretes a joint fluid called synovial fluid2. This synovial fluid is akin to oil on a hinge and helps the joint glide through its range of motion. After assessment of both whole-body movement and specific joint range of motion, we can identify joints that are likely to benefit from the therapy. From there we apply force to the segment at a high-velocity but low-amplitude in the direction where the joint is restricted assisting it through its full range of motion. It is at this point that sometimes the joint exhibits a phenomenon called a cavitation, which is often referred to as a “pop” but is when a mechanical force precipitates a gas bubble in a joint space creating an audible sound1. However, this phenomenon is not required to improve the function of the joint. Though this technique works well on its own, it is often used in conjunction with other techniques addressing the soft tissue as well as specific exercises to best treat all aspects of the biomechanical system that may be contributing to pain. Therefore, we like to combine different types of therapies in our treatment plans as we strive to achieve the best clinical outcomes for you!

– Sara Brand, DC

  1. LaPelusa A, Bordoni B. High Velocity Low Amplitude Manipulation Techniques. 2022 Jun 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 34662041.
  2. Juneja P, Hubbard JB. Anatomy, Joints. 2018 Available: (accessed 31.08.2022)