October 18, 2019; Volume 24; 102042

Kenneth A. Weber, Tor D. Wager, Sean Mackey, James M. Elliott, and two more: From Stanford University, The University of Colorado, the University of Sydney, the University of Illinois College of Medicine.


Spinal pain, affecting nearly one billion individuals worldwide, remains a leading cause of disability. Spinal manipulation, a common treatment for neck and back pain, is theorized to induce therapeutic mechanical changes in the spine. However, recent research suggests that its effects may extend beyond the mechanical realm, influencing pain-related brain activity. A groundbreaking study, utilizing functional magnetic resonance imaging (fMRI), delves into the intricate relationship between thoracic spinal manipulation and pain perception.

Key Points from the Study:

  • Prevalence and Significance of Spinal Pain:
    • Spinal pain is a widespread issue, affecting a significant portion of the global population.
    • It stands as a leading cause of disability, underscoring the importance of effective treatment modalities.
  • Mechanical Basis of Spinal Manipulation:
    • Spinal manipulation is a commonly recommended treatment for spinal pain, often combined with education and exercise.
    • Characterized by a mechanical thrust slightly beyond the passive range of motion, it is theorized to induce therapeutic changes in the spine.
  • Central Nervous System Mediation:
    • The therapeutic action of spinal manipulation may be partially mediated within the central nervous system (CNS).
    • Pain activation decreases following spinal manipulation, suggesting a central role in its therapeutic effects.
  • Thoracic Spinal Manipulation’s Effectiveness:
    • Thoracic spinal manipulation is effective in treating non-specific neck pain, comparable to cervical spinal manipulation.
  • Functional MRI and Pain Processing:
    • Functional MRI (fMRI) can map pain processing in the CNS, revealing a distributed network involved in the perception of pain.
  • Alteration of Pain-Related Brain Activity:
    • The study provides compelling evidence that spinal manipulation alters the processing of pain-related brain activity within specific regions.
  • Centrally Mediated Therapeutic Action:
    • Findings from the research support the concept of a centrally mediated therapeutic action of spinal manipulation.
    • Neck pain and brain pain region activation decrease following thoracic spinal manipulation.
  • Distinguishing Real vs. Sham Manipulation:
    • Results were not replicated following sham thoracic spinal manipulation, emphasizing the specificity of the effects.
  • Mechanisms of Action:
    • Spinal manipulation activates large diameter mechanoreceptors, inhibiting the transmission of nociceptive signals at the spinal cord.
    • Descending pain inhibitory pathways may contribute to the therapeutic action by reducing nociceptive signaling.


This study contributes significantly to the evolving understanding of spinal manipulation’s effects, shedding light on its potential central mechanisms in alleviating pain. As research continues to uncover the neurophysiological basis of spinal manipulation, it opens avenues for optimizing therapeutic strategies and improving patient outcomes in the management of spinal pain.