I’m seeing a physical therapist for neck pain that just started about two weeks ago. She’s been doing some heat and electrical stimulation. But now she wants to add a manipulation procedure to the middle of my back. She says it works well and there’s evidence in recent studies to support her experience. Does this sound like a good idea? I don’t really want my back popped.

Physical therapists, like everyone else in the health care field, are working hard to find ways to treat patients safely and effectively. Instead of treatment as usual, therapists are striving to find scientific evidence to support (or refute) current treatment approaches.

There’s plenty of evidence that thoracic spine thrust manipulation has a positive effect in treating patients with mechanical neck pain. Mechanical refers to generalized neck and/or shoulder pain that are made worse by certain neck positions, movement, or pressing on muscles of the head and neck. This indicates that the source of pain is one of the soft tissue structures, not coming from a fracture, infection, or tumor.

It’s also true that patients improve more with thoracic spinal manipulation procedure when combined with the heat and electrotherapy than with just heat and electrotherapy alone. A series of studies done by physical therapists in Spain on just this topic showed there was a greater reduction in neck pain, better function, and improved neck range of motion with multimodal (more than one treatment modality of technique) therapy.

It may take more than one manipulation. Most of the studies done included patients who had at least three thrust manipulations performed over a period of three to six weeks. It isn’t always the case that your spine will crack or pop with this treatment. If it does, the sensation isn’t usually painful as much as it just sounds like it should be.

Don’t hesitate to discuss your concerns and fears with your therapist. There may be other ways to approach your problem without joint manipulation. They may take longer to have the same effect, but they can alleviate your worries about snapping or popping the spine.