Does Technique Matter in Chiropractic?

Does technique matter in Chiropractic? Well, this depends on what is meant by technique. If we are discussing how a particular technique or intervention is performed, then yes. How a chiropractor applies a specific manipulation to a patient’s spine is very important, because performing the technique incorrectly, or poorly, might cause injury to either the patient, or the clinician, or both.

However, in the context of this blog, we are not discussing incorrect application or improper technique of a specific manipulation/technique. In this blog, we will discuss the different technique systems that can be found within the chiropractic profession. For patients and those outside of the chiropractic profession, it is reported that there is >300 different technique systems within chiropractic¹. A lot of these technique systems are named after the person who developed them, McTimoney chiropractic for example was developed by John McTimoney in the 1950’s². There are hundreds of these technique systems, including Gonstead technique and Thompson technique to name a few of the more popular and well-known technique systems. There is even Diversified technique with a capital D and diversified with a lower-case d. The distinction between these two is diversified with a lower-case d is not a specific technique, but an amalgamation of lots of aspects of different technique systems, whereas capital D Diversified is actually a specific technique.

Why is this important? Why am I writing this blog? The reason for this blog is to ask the simple question, does technique matter in Chiropractic?

When I was at university, there was an enormous amount of energy being put into specificity of the adjustment or thrust³. The hypothesis was all about the clinician’s ability to manipulate a specific spinal segment, rather than applying a force that impacted the adjacent segments. For example, in a hypothetical scenario, a patients’ fourth cervical vertebra (C4) in their neck was restricted in its movement. The logic and the study at the time was focused on a clinician’s ability to only manipulate C4³.

However, the research literature doesn’t support the assumption that a single level can be manipulated in isolation ⁴. This is because the spinal segments do not work in isolation, instead the movement we experience is due to complex mechanisms known as main motions and coupled motions⁵. In a nutshell, the main motion is main movement direction of the spinal segments (e.g., turning or rotation to the right). For this example, we will stick with the neck to make things as easy as possible. Coupled motions are when areas/segments of the spine function in a combination of directions in order to create a global movement. Even during what could be considered a simple movement, like turning your head to the right, is a complex movement made up of multiple directions of motion performed by the vertebrae of the neck. When turning your head to the right, 60% of this initial turning (rotating) motion occurs in the upper segments, between C1 and C2⁶ (main motion). This is created by the unique anatomical structures of C1 (the Atlas) and C2 (the Axis). Therefore, the remaining 40% of the range of motion must be created by the remaining five cervical vertebrae. The remaining motion is not created by pure rotation of the remaining vertebrae, it is created by a mixture of rotation (turning) and sideways (lateral) bending⁷. The motion of the segments of the spine is dictated by the shape of the joints themselves.

“Structure dictates function”

So, it is not possible to manipulate a single segment of the spine like some manual therapists/chiropractors claim. But this is a side note, really, separate from the main topic of this blog. The reason I brought this up is because, there are several high quality studies demonstrating no difference in pain relief or patient outcomes following either targeted or non-specific spinal manipulation^8–10. So the question then becomes, “does technique matter in chiropractic?” If a specific adjustment or thrust aimed at the C4 vertebra alone provides the same pain relief as an adjustment aimed at manipulating multiple vertebra in the neck, or even the whole neck, then clearly technique doesn’t matter, because the response is the same.

However, with that being said, what ever technique is being employed, what is incredibly important is your technique, or your skill… how good the clinician is at performing the task itself. This is rather obvious, but I feel it needs to be said. As long as the clinician achieved the goal set out from the start, and does it well, the likelihood is, it will provide benefit to the patient. As we will now discuss, it doesn’t matter how it is achieved, as long as it is performed well.

Why Doesn’t Technique Matter?

We have discussed in a previous blog post “How Chiropractic Works”, where we discuss in detail the mechanisms behind how spinal manipulation works. In a nutshell, it is the bombardment of the central nervous system and stimulation of the thalamus on the brain that causes a reduction in pain signals and helps to restore normal spinal control¹¹.

Studies have compared manipulation to mobilisation, where the spine is gently mobilised without causing the audible “pop” (cavitation). These studies have concluded that there is little evidence that full manipulation is better for managing back or neck pain than mobilisation¹². Whilst we are on the topic of alternatives to manipulation, in a randomised clinical trial comparing conventional pain medications (non-steroidal anti inflammatory medications), spinal manipulation and acupuncture, manipulation was found to perform the best for the treatment of chronic spinal pain¹³. However, their data did not strongly support any one modality alone, instead proposing that a combination of these three might be more effective than any one alone¹³.

What about exercise for pain?  Well, in a couple of randomised clinical trial, Bronfort and colleges concluded spinal manipulation with strengthening exercises was more effective for the management of chronic neck and low back pain than manipulation alone^14,15. It is therefore clear from the literature that, there are many ways to achieve pain relief using manual techniques, be it manipulation, mobilisation or exercise, but where to we go from here? What is the over arching point being made here? Well, I’m so glad you asked!

As with any and all things in medicine, some treatment interventions are more appropriate and therefore more suitable to some people and not others. Spinal manipulation is not for everyone, with some people being at risk of their pain being made worse by it. So selecting the right treatment, for the right patient, at the right time is key to a successful outcome. This is why here at Spriggs Chiropractic, we utilise many different techniques and strategies in the treatment and management of spinal and other joint pains. We take your case and apply an individualised plan of management that suits you and your healthcare needs. For more information, do not hesitate to contact the clinic to book your consultation now on 01635 43238 or email hello@spriggschiropractic.co.uk.

“The right treatment, for the right patient, at the right time.”

Conclusion

The point I am making here is, learning how to effectively apply and utilise different techniques for manipulating the spine is a good thing, because not one technique has all the answers for helping patients. Some technique systems out there have different ways of manipulating the patients’ in different postures and positions that are more appropriate for some patients than others. Ultimately, it depends doesn’t it? It depends on the patient and their demographics (e.g., age, physical size, physical ability and if any disabilities need to be considered). There are clearly going to methods of manipulation that are safe to apply to adults, that can’t be applied to children and vice versa. How well you identify the appropriate techniques and apply them is the key for effective clinical practice.

A strategy I teach and talk to students is to attend as many different technique seminars as possible to learn when best to employ it for the most appropriate patient at the right time. Not everyone is a candidate for spinal manipulation, because nothing is risk free, and not all spines can tolerate it. Not everyone can perform exercises either, so selecting the correct treatment/management strategy for the right person is key.

As always, I hope you enjoyed this blog post as much I enjoy writing it. I always enjoy finding and reading through the scientific literature to form a balanced and evidence-based conclusion to help inform and educate those who want to read them. If you have any topics you have questions over regarding chiropractic or manual therapy related topics, leave a comment below and I will do my best to cover the topics you want to discuss.

For more information, please contact the clinic via email on 01635 43238 or email hello@spriggschiropractic.co.uk

References:

1. Byfield D. Introduction to Manipulative Skills. In: Chiropractic Manipulative Skills. 2nd ed. Elsevier; 2005:3.
2. Cartlidge S. McTimoney chiropractic: a gentle way with back pain. Complement Ther Nurs Midwifery. 1997;3(5):136-141. doi:10.1016/S1353-6117(97)80014-5
3. Bergmann TF, Peterson DH. Principles of Adjustive Techniques. In: Chiropractic Technique: Principles and Procedures. 3rd ed. Elsevier Mosby; 2011:87.
4. Herzog W. The biomechanics of spinal manipulation. J Bodyw Mov Ther. 2010;14(3):280-286. doi:10.1016/j.jbmt.2010.03.004
5. Harrison DE, Harrison DD, Haas JW, Oakley PA. Spinal Biomechanics for Clinicians: Volume 1. Harrison CBP Seminars, Inc; 2003.
6. Patel AA, Spiker WR, Ghanayem AJ. Functional Anatomy of Joints, Ligaments and Disks. In: The Cervical Spine. 5th ed. Lippincott Williams & Wilkins; 2012:44.
7. Ivancic PC, Dvorak J, Goel VK, Fairchild TA, White III AA, DiAngelo DJ. Cervical Spine Kinematics and Clinical Instability. In: The Cervical Spine. 5th ed. Lippincott Williams & Wilkins; 2012:53-72.
8. Nim C, Aspinall S, Cook C, et al. The Effectiveness of Spinal Manipulative Therapy in Treating Spinal Pain Does Not Depend on the Application Procedures: A Systematic Review and Network Meta-analysis. J Orthop Sports Phys Ther. 2025;55(2):33-37.
9. Minnucci S, Innocenti T, Salvioli S, et al. Benefits and Harms of Spinal Manipulative Therapy for Treating Recent and Persistent Nonspecific Neck Pain: A Systematic Review With Metaanalysis. J Orthop Sports Phys Ther. 2023;53(9):510-528. doi:10.2519/jospt.2023.11708
10. Sørensen PW, Nim CG, Poulsen E, Juhl CB. Spinal Manipulative Therapy for Nonspecific Low Back Pain: Does Targeting a Specific Vertebral Level Make a Difference?: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther. 2023;53(9):529-539. doi:10.2519/jospt.2023.11962
11. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyogr Kinesiol. 2012;22(5):768-776. doi:10.1016/j.jelekin.2012.02.012
12. Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: A systematic review and best evidence synthesis. Spine J. 2004;4(3):335-356. doi:10.1016/j.spinee.2003.06.002
13. Giles LGF, Muller R. Chronic spinal pain: A randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine (Phila Pa 1976). 2003;28(14):1490-1502. doi:10.1097/00007632-200307150-00003,
14. Bronfort G, Evans R, Nelson B, Aker P, Goldsmith C, Vernon H. A Randomized Clinical Trial of Exercise and Spinal Manipulation for Patients With Chronic Neck Pain. Spine (Phila Pa 1976). 2001;26:788-799.
15. Bronfort G, Maiers MJ, Evans RL, et al. Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: A randomized clinical trial. Spine J. 2011;11(7):585-598. doi:10.1016/j.spinee.2011.01.036