Of all the questions we get asked in the treatment room, this is the one people lower their voice for: is it actually safe to have your back clicked? It usually comes from someone who has been told by a friend that it is dangerous, or who had it done years ago and has been wary of it ever since.
It is a fair question and it deserves a straight answer rather than a sales pitch. At our Bromley clinic we use spinal manipulation most weeks, but on far fewer people than you would think, and almost never on its own. Here is what the click actually is, what the technique can and cannot do, and when we leave it well alone.
What the click actually is
The sound has nothing to do with bones going back into place. When a joint in your spine is taken quickly to the end of its available range, the two joint surfaces separate very slightly and the pressure inside the joint capsule drops. Gas comes out of solution in the fluid inside that joint and forms a bubble, and that is the pop you hear. It is the same mechanism as cracking a knuckle.
Which means some of the popular explanations are simply wrong. Nothing is being put back in. Your vertebrae were not out of place to begin with — a bone genuinely out of position is a dislocation or a fracture, and you would be in hospital, not on a treatment couch. Nothing is being realigned, and nobody can lengthen your leg with a click.
Does the click mean it worked?
No, and this one tends to surprise people. Researchers have looked at whether hearing an audible pop predicts a better outcome, and it does not appear to. What seems to matter is that a stiff segment moves and that the muscles guarding it ease off for a while afterwards. The noise is a by-product.
So a therapist who repositions you three or four times until something sounds is chasing the wrong thing. If the joint moves and your pain eases, it has done its job, noisily or silently.
What spinal manipulation can and cannot do
Being honest about the ceiling of a technique is more useful than overselling it. It is reasonable to expect:
- a short-term drop in pain and stiffness around a specific joint that was not moving well
- easier movement in a direction you had been guarding or avoiding
- a window of a few days in which soft tissue work and exercise feel easier
It is not reasonable to expect it to correct your posture, repair a disc, cure sciatica, or hold on its own for months. Current UK guidance on low back pain says much the same thing: manual therapy — manipulation, mobilisation or soft tissue work — is recommended only as part of a package that includes exercise, not as a treatment in its own right. That matches what we see. The people who get a lasting result are the ones who do the exercise programme between appointments; the ones who come back every few weeks for another click are usually treating the symptom and leaving the cause alone.
How it feels, and what to expect afterwards
A manipulation is quick, firm and over in a second. It should not be painful. Most people describe a sensation of release rather than discomfort, and the anticipation is generally worse than the thing itself. If you tense up and brace, we stop — a guarded joint does not move well anyway.
Afterwards, mild soreness or stiffness for a day or two is fairly common. Most people find it settles within 24 to 48 hours. Feeling unusually tired that evening happens too. Anything sharper or longer-lasting than that is worth telling us about.
When clicking is not the answer
There are plenty of situations where we use hands-on soft tissue work, medical acupuncture or exercise instead and skip manipulation entirely:
- thinning bones, known osteoporosis, or long-term steroid use
- recent significant trauma, or any suspicion of a fracture
- a flare-up of inflammatory arthritis
- blood-thinning medication
- pregnancy, where we adapt what we do
- nerve symptoms that are getting worse, particularly weakness
- a joint that is already too mobile rather than too stiff
- anyone who simply does not want it, which is a complete reason on its own
That second-to-last point explains something people often ask. If you can click your own neck or lower back repeatedly, all day, that segment is not stiff — it is loose and moving too readily, usually to compensate for a genuinely stiff neighbour that nobody has looked at. Clicking it again gives a few minutes of relief and reinforces the pattern. The joint that needs the attention is almost always the quiet one next door.
Red flags: see a doctor, not a therapist
Some symptoms are not ours to treat. Go to A&E or call 999 if you have:
- numbness around the saddle area, or difficulty controlling your bladder or bowels
- weakness in both legs, or weakness that is spreading or worsening
- sudden severe neck pain or headache with dizziness, slurred speech, double vision or facial numbness
Book with your GP rather than a therapist if you have back or neck pain alongside unexplained weight loss, a fever, pain that is markedly worse at night and unrelated to movement, or a history of cancer.
What treatment usually looks like at our Bromley clinic
A first appointment is mostly assessment: what you can and cannot move, where the stiffness genuinely sits, and whether the painful area is the cause or the victim. Treatment then tends to be a combination — soft tissue work, sometimes spinal manipulation if a specific segment is stiff and there is no reason to avoid it, sometimes needling, and always something to do at home. Most people with a straightforward stiff, achy back need two to five sessions, not a standing weekly appointment.
Book spinal manipulation in Bromley
SMSM Therapy, Carlton Chambers, 5 Station Road, Bromley BR2 0EY. Come to the red side gate to the right of the building — we are a three-minute walk from Shortlands station.
Call or text 07896 257328, email info@smsmtherapy.co.uk, or book online. You can see our prices and how to find us before you come.
We see clients from Bromley, Beckenham, Shortlands, Hayes, West Wickham, Chislehurst, Petts Wood and Orpington.
Written by Dharam Vyas, sports therapist and clinic director at SMSM Therapy, Bromley.
