What Happens When an Osteopath ‘Cracks’ Your Back?

If you have been to a Chiropractor or an Osteopath before, you may have heard about spinal manipulation (cracking the spine or a joint). If not, you may have seen videos on YouTube about it, heard a friend speak about it or read it somewhere online.

Okay, by now I’m sure that you know what an Osteopath is. If you don’t know, here’s a quick recap. (Or, you could always check our previous post: What is Osteopathy? What are some common misconceptions about this profession?)

What is Osteopathy? A Quick Recap

Osteopathy is a patient centred health practice that focuses on the joints, the muscles and the spine. It uses an evidence-based, holistic approach to healthcare involving hands on treatment (manual therapies), health education, lifestyle management and exercise rehabilitation. People visit an osteopath for issues such as neck, shoulder, knee and leg pain, lower back pain, sports and workplace injuries, postural issues, arthritis, osteoporosis, and much more.

Ok, now that we’ve covered that, let’s look at what happens when an Osteopath uses spinal manipulations.

What happens when an Osteopath ‘cracks’ your back?

Osteopath doing a neck spinal manipulation on a women patient
Many of my patients asked me the same questions:

  • What is spinal manipulation?
  • How does spinal manipulation work?
  • Why do Osteopaths ‘crack’ the spine?
  • Does spinal manipulation hurt?
  • Are spinal manipulations safe?

So, I am writing this blog because I have heard these questions nearly every week and I believe that knowing is conquering. Having all the information about treatment can help you to decide if you want it to be performed on you or not. Yes, you can say NO to a treatment.

Consent is an integral part of your treatment, and many of my patients have asked me not to manipulate their back or their neck – Which is totally okay!


Spinal manipulation is a manual therapy technique (hands-on body) that moves your joint very fast with minimal force. We also call it HVLA, which stands for High Velocity and Low Amplitude. This technique ‘sometimes’ makes a cracking noise of your joint. You may be surprised to know that the precise result of the treatment is unknown [1]. Historically, it was thought that it was releasing entrapped synovial folds from your joint, relaxing your muscle tension due to the sudden stretch, changing some articular adhesions and joint segments positioning.


  • Putting your back or your joint back into place [1]
  • Move one vertebra over another [1]
  • Fixing a subluxation of your spine [2]
  • Curing back pain, neck pain, allergies, reduce asthma, preventing the need for vaccines or reducing infectious illnesses with the technique [3, 4]
  • Having a long-lasting effect with manual therapies like manipulation [5-8]
  • Activating some function of your immune system [10]


We are not putting back your vertebrae or joints into place. Even though the cracking noise can make you think differently, it seems that the noise comes from gas that is trapped within your joint. To simplify the explanation, check out this video:

What we do know through the latest research is that spinal manipulation may impact:

· Your autonomic nervous system [9]

· Decrease cortisol levels [11]

· Generate changes in your brain in the area such as anterior cingular cortex, amygdala, PAG, RVM and cerebellar vermis [12]

Similarly, well-known spinal manipulation teachers in the UK from OMT training, Gyer, Michael [13] found evidence of the different effects of the techniques. These effects varied between neurophysiological effects (the effect it has on your brain) on central neuroplastic, muscle strength, the rise of cortical drive or activation of descending pain pathways (again brain mechanism).

However, as the researchers mentioned in their scientific paper: most of the studies were weak in their methodology approaches, designs or had no intervention group.

So, despite positive arguments, other researchers like Colombi and Testa [10] advocate for better research with bigger sample sizes, a clearer understanding of the mechanism of action, and more rigorous methodology to provide a final definite conclusion.

So, as I said before, we don’t know the exact mechanism of this technique.

Now, does it mean that I’m not using spinal manipulation in the clinic? No. What it means is that I’m using spinal manipulative techniques for the right patient. Not all conditions need to be addressed with spinal manipulation. Everyone is different, and so everyone will react differently to the technique. There is a big difference between short-term pain and long-term pain too. But this is for another post.

For your information – This technique shouldn’t hurt at all.

Remember what I said above: minimal force. If it hurts, there is something wrong. And that’s the reason why there are some safety measures to take before doing any type of treatment. You need to do a patient interview and a physical examination with a healthcare professional to determine if you are the right candidate for spinal manipulation. Yes, your personal medical history and our clinical testings can determine the risks vs the benefits. Between you and I, a spinal adjustment should be strictly performed by university-trained Allied Health professionals (Chiro/Physio/Osteo) who is registered health practitioners from APHRA, the Australia Practitioner Health Regulation Agency.

Osteopathic care is recognised as being safe for a wide range of conditions, although, it is essential to inform you that some health care procedures such as manual therapies can induce adverse events or complications. Similar to other health procedures, there can be risks. Most of these adverse events or risks are rare, but you should be aware of them before the treatment. Increased symptoms can occur 24 – 48 hours after treatment and generally subside after this period. However, it is essential to contact your practitioner after 2 to 3 days if increased symptoms are still present. Manual therapies involving spinal manipulations of the cervical spine (neck) also include some risks and side effects. Those risks are rare; some treatments of the neck can damage blood vessels and even give rise to stroke-like symptoms. It is believed the risk may be approximatively 1-2 strokes per 1,000,000 neck manipulations [14-17].

That’s the reason why we assess your situation to see if you are a good candidate for this technique. High blood pressure, blood circulation issues, recent accident or trauma, osteoporosis and other factors can be the reason why I wouldn’t do this kind of treatment on you.

Please don’t be scared to come to see an Osteopath; spinal manipulations are not mandatory. Osteopaths do more than what you think. We have more than just one technique under our sleeves.

Osteopaths are trained to provide:

  • Musculoskeletal and nervous system assessments – They use a range of tools to identify what might be happening in the body
  • Manual therapy – Includes a range of ‘hands-on’ techniques that may give relief from musculoskeletal pain, discomfort and may help tissues in the body
  • Clinical exercise programs – Activities and movement strategies for use at home, work or in other settings. Exercise may help you return to activities you enjoy, for example, after an injury or surgery
  • Movement, postural, positioning advice and ergonomic assessments
  • Therapeutic needling techniques, like dry needling, trigger point therapy or acupuncture
  • Advice about your lifestyle, stress management, diet or other factors that may influence your pain, injury or movement

If you have any doubts that Osteopathy is right for you, you should look at our last blog post. I always explain my treatment approach to my patients before doing anything. I repeat: Your consent is vital in your treatment plan, and you can say no and stop at any time.

Now you know what happens when Osteopaths ‘crack’ your back or your neck.

On a final note, I wanted to tell you something significant. Spinal manipulations are a tool and not a solution to your problem. If you have chronic back pain, it will take you more than just manual therapies to help you with your condition. That’s why I love Osteopathy – I’m not just ‘cracking’ your back and off you go. Osteopath use a holistic approach to understand your situation, find the cause of your problem and develop a management plan that fits your lifestyle and your needs. Our approach really looks at all the internal and external factors affecting your health. We look at you as a whole system, including your body and environment. At the Mana Health Clinic, I work with my patients closely to give them the right support for their condition.




1. Gyer, G., et al., Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation. J Integr Med, 2019. 17(5): p. 328-337. https://www.sciencedirect.com/science/article/abs/pii/S2095496419300597?via%3Dihub

2. Mirtz, T.A., et al., An epidemiological examination of the subluxation construct using Hill’s criteria of causation. Chiropractic & osteopathy, 2009. 17: p. 13-13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3238291/

3. Kawchuk, G., et al., The Effect of Spinal Adjustment / Manipulation on Immunity and the Immune System: A Rapid Review of Relevant Literature. World Federation of Chiropractic. 2020. https://www.wfc.org/website/images/wfc/Latest_News_and_Features/Spinal_Manipulation_Immunity_Review_2020_03_19.pdf

4. Hondras, M.A., K. Linde, and A.P. Jones, Manual therapy for asthma. Cochrane Database Syst Rev, 2005(2): p. Cd001002. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001002.pub2/full

5. Bredow, J., et al., [Conservative treatment of nonspecific, chronic low back pain : Evidence of the efficacy – a systematic literature review]. Orthopade, 2016. 45(7): p. 573-8. https://www.ncbi.nlm.nih.gov/pubmed/27075679

6. Coelho, M., et al., The effectiveness of manipulation and mobilization on pain and disability in individuals with cervicogenic and tension-type headaches: a systematic review and meta-analysis.Physical Therapy Reviews, 2019. 24(1-2): p. 29-43.https://www.tandfonline.com/doi/abs/10.1080/10833196.2019.1572963

7. Masaracchio, M., et al., Thoracic spine manipulation for the management of mechanical neck pain: A systematic review and meta-analysis. PLoS One, 2019. 14(2): p. e0211877. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373960/

8. Steuri, R., et al., Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. British Journal of Sports Medicine, 2017. 51(18): p. 1340. https://bjsm.bmj.com/content/51/18/1340.long

9. Minarini, G., M. Ford, and J. Esteves, Immediate effect of T2, T5, T11 thoracic spine manipulation of asymptomatic patient on autonomic nervous system response: Single-blind, parallel-arm controlled-group experiment. International Journal of Osteopathic Medicine, 2018. 30: p. 12-17. https://www.journalofosteopathicmedicine.com/article/S1746-0689(17)30154-2/abstract

10. Colombi, A. and M. Testa, The Effects Induced by Spinal Manipulative Therapy on the Immune and Endocrine Systems. Medicina, 2019. 55(8). https://pubmed.ncbi.nlm.nih.gov/31394861/

11. Sampath, K.K., et al., Neuroendocrine Response Following a Thoracic Spinal Manipulation in Healthy Men. Journal of Orthopaedic & Sports Physical Therapy, 2017. 47(9): p. 617-627. https://pubmed.ncbi.nlm.nih.gov/28704625/

12. Sparks, C., et al., Supraspinal structures may be associated with hypoalgesia following thrust manipulation to the spine: a review of the literature. Physical Therapy Reviews, 2013. 18(2): p. 112-116. https://www.tandfonline.com/doi/abs/10.1179/1743288X12Y.0000000058

13. Gyer, G., et al., Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation. Journal of Integrative Medicine, 2019. https://www.sciencedirect.com/science/article/abs/pii/S2095496419300597?via%3Dihub

14. Ernst, E., Adverse effects of spinal manipulation: a systematic review. Journal of the Royal Society of Medicine, 2007. 100(7): p. 330-338. https://pubmed.ncbi.nlm.nih.gov/17606755/

15. Biller, J., et al., Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the american heart association/american stroke association. Stroke, 2014. 45(10): p. 3155-74.https://pubmed.ncbi.nlm.nih.gov/25104849/

16. Haynes, M.J., et al., Assessing the risk of stroke from neck manipulation: a systematic review. Int J Clin Pract, 2012. 66(10): p. 940-7. https://pubmed.ncbi.nlm.nih.gov/22994328/

17. Whedon, J.M., et al., Risk of stroke after chiropractic spinal manipulation in medicare B beneficiaries aged 66 to 99 years with neck pain. J Manipulative Physiol Ther, 2015. 38(2): p. 93-101. https://pubmed.ncbi.nlm.nih.gov/25596875/

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