Whether Manipulation helps is a long held dispute. Despite some positive studies, argument still rages whether this is better than “usual care”. This would have to assume millions of people getting manipulation are crazy.
read controversy here
Anyone who has done manipulation has had cases with dramatic results and hence has seen the benefits. The question is whether this immediate analgesic effect obtained by “cracking”/popping-air into joints leads to persistent help. Answer would depend on what are we treating. Their is no differentiation in that controversy though the argument is that certain subgroups would fair better:
Disc disease – MacKenzie techniques
Facet disease – segmental manipulation if not unstable
Sacroiliac disease – manipulation but will need treatment for instability.
Given that back pain is a multidimensional disease that suffers from ceiling effects (miss one problem -may not feel any better as one problem takes them to their pain ceiling), it is not reasonable to expect manipulation by itself to do the trick. Most often, it is an add-on to massage and other techniques. Subjects recruited for studies are going to be the hard-tack cases which do not represent the general population.
Would like to hear opinions from chiropractors and such.
Addendum –
Orthop Sports Phys Ther. 2010 Mar;40(3):133-40.
The addition of cervical thrust manipulations to a manual physical therapy approach in patients treated for mechanical neck pain: a secondary analysis.
Boyles RE, Walker MJ, Young BA, Strunce J, Wainner RS. abstract here
found that physiotherapy without thrust can get comparable results to physiotherapy with thrust manipulation.
This is a relief to me- I avoids neck thrusts and do more gentle “muscle energy techniques”, myofascial release, manual neck traction, and massage.
I am a chiropractor who uses all the tools at my disposal – neuromuscular re-education, soft tissue manipulation, mobilization, physiotherapy and manipulation. I personally think that in some cases it does make a difference. I ease patients into manipulation, especially if they have never had it done before. I often see a better result after adding that into the treatment plan, but not always. I do think that not addressing soft tissue, posture, muscle balance and motor control is a mistake though.
Whether manipulation makes a difference depends on the patient and the condition, but can be very helpful.