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Manipulation of the cervical spine or neck region is a common technique utilized by doctors of chiropractic for many patients complaining of neck, upper back, and shoulder/arm pain, as well as headaches.

Similar to the treatment for many conditions affecting the low back, chiropractic is considered as a first line of treatment for a range of cervical spine conditions. The chiropractic treatment goals for cervical spine complaint management include (but are not limited to) some combination of:

  • Reducing pain
  • Improving motion
  • Restoring function to the head and neck region

These goals are usually accomplished by the use of a number of different approaches. The primary focus of this article is on chiropractic manipulation.

Patients should be advised that the application of this treatment approach only occurs after a full patient history, physical examination, review of past, family, social histories, and review of systems have been completed. Tests resulting from this process may include X-ray, CT, MRI, EMG/NCV, laboratory blood and urine analysis, referral to a specialist, and/or possibly more, depending on each individual case presentation.

Types of Chiropractic Manipulation

There are two general chiropractic manipulation approaches for cervical spine complaints:

  • Cervical spinal manipulation – often thought of as the traditional chiropractic adjustment, or a high-velocity, low-amplitude (HVLA) technique
  • Cervical spinal mobilization – which is a more gentle/less forceful adjustment, or a low-velocity, low-amplitude (LVLA) technique moving the joint through a tolerable range of motion.
  • The combination of the various approaches varies from patient to patient depending on the chiropractor’s preferred techniques and preferences, the patient’s comfort and preferences, and the patient’s response to the treatment, as well as both past experience and observations made during the course of treatment.
  • Instrument Assisted Adjustment

    Some chiropractors may also use tools as part of the adjustment technique. Probably the most commonly used tool is the “Activator.” The Activator is a small, spring-loaded hand-held device that may be used to adjust a cervical vertebra.

    Cracking Sound During the Adjustment

    The HVLA manipulation usually results in a release, called cavitation, which is created in part by gas escaping from the joint capsule when the joint is moved quickly within its passive range of motion, well within the tissue boundaries.
    This type of chiropractic adjustment creates the typical cracking sound that is often associated with joint manipulation. It sounds similar to cracking one’s knuckles.
    While this cracking description of a chiropractic high-velocity, low-amplitude thrust may give an impression of something that is uncomfortable, many patients find the sensation is relieving and may provide immediate relief of painful symptoms.
    The Activator is just one example; there are other instrument-assisted manipulative devices also utilized by chiropractors, some of which offer more of a pulsating stimulation to adjust the cervical vertebral segment.


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