Spinal Manipulation vs. Massage: Which Fits Your Back Pain?

Back pain sends people to both chiropractors and massage therapists, and many wonder which to book first. Both are hands-on, both have research behind them for low back pain, and neither is a guaranteed fix. Here is how they differ and how to choose.

What spinal manipulation is

Spinal manipulation, often called an adjustment, is when a trained provider applies a controlled force to a joint in the spine. Some adjustments produce a popping or cracking sound. Others, like flexion-distraction, feel more like a controlled stretch. Our chiropractic care includes Diversified, Thompson, Gonstead, Activator, ArthroStim and flexion-distraction techniques, and if you dislike one, we can usually use another.

What massage therapy is

Massage works on muscle and soft tissue. Our licensed massage therapists offer deep tissue, myofascial release, relaxation massage and focused work on a problem area, in 30, 60 or 90 minute sessions. You do not need to be a chiropractic patient or have a referral to book.

What research says about low back pain

The American College of Physicians' 2017 guideline tells doctors and patients to start with non-drug treatment for acute and subacute low back pain, and names superficial heat, massage, acupuncture and spinal manipulation as options. For chronic low back pain, the same guideline lists exercise first, and spinal manipulation appears on its list of options. Massage does not.

For spinal manipulation, a 2017 JAMA analysis of acute low back pain trials found modest improvements in pain and function for up to six weeks, with minor, temporary side effects. The National Center for Complementary and Integrative Health describes the benefit the same way: small improvements in pain and function.

For massage, a Cochrane review found short-term relief of pain and better function in subacute and chronic low back pain compared with no treatment, and less benefit over the long term. The reviewers rated the evidence low to very low quality.

Put plainly: both are reasonable options, the benefits are modest, and neither has strong evidence of lasting results on its own. If your back pain has lasted a while, rehab exercise is part of the conversation too.

Safety

The NCCIH page on spinal manipulation says mild to moderate side effects, such as soreness, stiffness or a headache, usually fade within a day. Serious problems are very rare, but no one has an accurate estimate of how often they happen, and the risk may be higher in people with other health problems. That is why we ask about your health history and medications before we adjust. The Cochrane review found no clear difference in side effects between massage and the comparison groups, though the evidence was weak.

How to choose

There is no research-backed rule for which one to try first, so we decide together after a conversation and an exam. Many people use both, and the plan can change as you improve.

What the first visit looks like

We start by talking about what brought you in, then review your history and examine you. Digital X-rays are available, but only if they are clinically necessary. We explain what we find before any treatment, and if chiropractic care is appropriate, treatment can often begin the same day. We do not require long-term contracts or prepaid plans, and if we do not think chiropractic is the right fit, we will tell you. More detail is on our first visit page.

When to get medical care first

MedlinePlus advises calling your health care provider if back pain is severe or has not improved after three days, and getting medical attention for back pain after an injury. The NHS (a UK source) lists emergency warning signs: pain, tingling, weakness or numbness in both legs, numbness around the genitals or anus, new bladder or bowel problems, or pain that began after a serious accident. If you have any of these, go to the nearest emergency room or call 911.

Book a visit

Not sure which fits? Call or text 484.455.4664 or book online. Keep It Kinetic Chiropractic, 3254 W Ridge Pike, Suite 202, Pottstown, PA 19464. Related: back pain care.