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Spinal Manipulation

Spinal manipulation, also called osteopathic manipulative treatment (OMT) or manual therapy, is a non-invasive diagnosis and hands-on therapy that integrates osteopathy, chiropractic therapy and physical therapy. OMT is used to diagnose, treat and prevent illness or injury. In certain cases, it can be used as an alternative for, or in conjunction with, medication or surgery.

Spinal manipulation is one technique from the spectrum of manual therapies that is most often used to treat pain in the neck or back, although it also can relieve discomforts of the musculoskeletal system, which includes all of our joints and muscles throughout the body. This therapy uses mobilization and manipulation techniques to help restore full movement to restricted joints, as well normal elasticity to muscles and other soft tissues. Restoring mechanical and soft tissue balance benefits the structures of the entire body and its physiological mechanisms.

Numerous studies have investigated the effects of spinal manipulation for lower back or neck pain. Although the results are mixed, several studies have shown that, generally, spinal manipulation is a safe and effective alternative or complement to drugs and surgery traditionally used to treat these conditions. Research also has shown that patients with neck or back pain who receive spinal manipulation recover faster and use less medication and physical therapy, reducing both costs to the patient, as well as the risks associated with the use of anti-inflammatory drugs (NSAIDS), which are commonly prescribed for spine-related pain.

At the UCSF Osher Center for Integrative Medicine, you will be treated by a board-certified medical doctor who incorporates osteopathic manipulative treatment into his spectrum of care.

Osteopathic doctors are similar to other medical doctors in that they are medically trained and licensed to perform surgery and radiology, can prescribe medication and can specialize in any area of recognized medicine. However, they have additional training in manual therapies, which makes them more attuned and experienced in regards to problems affecting the musculokeletal system.

Like all doctors at the Osher Center, osteopathic doctors focus on the entire person to provide care and respect your body as an integrated whole. Rather than simply treating your symptoms, they investigate and treat the underlying causes of your discomfort. In doing so, they assess your physical condition as well as other external factors such as your family life, job and stress level.

Conditions Treated

Spinal manipulation, or manual therapy in general, can be used as a therapy for numerous pain problems of the musculoskeletal systems, which can be associated with other disorders such as asthma, menstrual pain, headaches, sinus disorder and carpal tunnel. However, the therapy is most often used to treat back and neck pain.

Four out of five adults will suffer from at least one bout of back pain at some time in their life. Bearing most of the weight and stress, the lower back is the most common site for pain. An estimated 65 million Americans suffer from lower back pain each year. Back pain can occur for no apparent reason or as the result of a mechanical injury. Frequent causes of lower back pain may include osteoarthritis, poor or increased muscle tone, muscle strains, excess weight and improper or heavy lifting. Poor posture and sitting or standing in one position for a long time also can put extra stress on your back.

In addition to back pain, spinal manipulation can be used to treat the following:

  • Acute and chronic musuloskeletal pain, especially around the spine
  • Neck pain
  • Shoulder pain
  • Sciatica


At your initial consultation, the osteopathic doctor will first ask you about your health concerns and determine how your symptoms can best be treated with manual therapy. You then will have a structural exam, during which the doctor will assess your posture, spine and balance. He or she will check your back, extremities, muscles, tendons and ligaments for tenderness as well as your joints for restriction during movement.

Based on your medical history, as well as your physical and mechanical findings, the doctor will decide whether spinal manipulation or manual therapy is an appropriate treatment for you. A treatment plan will be designed to meet your specific needs.


During a spinal manipulation treatment, your osteopathic doctor may perform specific manipulations to release pressure in your affected joints, align your muscles and joints and improve blood circulation to maintain and restore health.

Your visit also may include gentle stretching and mobilizing techniques, exercises and discussion about what you can do to alleviate symptoms and improve your overall health and quality of life. Osteopathic doctors work to identify and treat the underlying causes of poor health and function in each patient. Depending upon the severity of your problem, more than one visit may be required.


Reviewed by health care specialists at UCSF Medical Center.

Related Information

UCSF Clinics & Centers

Osher Center for Integrative Medicine
1545 Divisadero St., Fourth Floor
San Francisco, CA 94115
Phone: (415) 353-7700
Fax: (415) 353-7358

Our Experts

Wolf Mehling
Dr. Wolf Mehling,
family and integrative medicine specialist