Spinal Manipulation & Back Pain Relief: Why Specific Levels Don’t Matter as Much as You Think
If you’re struggling with lower back pain, sciatica, or spinal discomfort, you might have come across spinal manipulation as a treatment option. Whether you’ve been told your L4-L5 or L5-S1 needs “adjustment” or that a certain spinal joint is the source of your pain, it’s easy to assume that treatment needs to be highly specific to be effective.
But here’s the truth: Spinal manipulation can be beneficial—but it’s not all about targeting a precise spinal level. Research shows that the pain-relieving effects of manual therapy are broader than we once thought, and long-term recovery always requires active rehabilitation alongside hands-on treatment.
In this post, we’ll explain why focusing too much on specific spinal levels may not be necessary and why combining spinal manipulation with exercise therapy is the best approach to overcoming chronic back pain.
What is Spinal Manipulation, and How Does It Help?
Spinal manipulation, or manual therapy, is a hands-on treatment used by physiotherapists to reduce pain, improve mobility, and relieve muscle tension. Techniques such as joint mobilization, spinal adjustments, and soft tissue release can be effective in helping individuals suffering from:
Lower back pain (acute and chronic)
Sciatica or nerve-related pain
Neck pain and stiffness
Spinal joint dysfunction or stiffness
Postural-related discomfort
Many people feel immediate relief after spinal manipulation, but what’s actually happening? Contrary to popular belief, these treatments don’t necessarily “realign” the spine. Instead, they likely work by:
Modulating the nervous system – influencing how the brain perceives pain, and most likely the main mechanism of spinal manipulation’s effectiveness.
Stimulating blood flow and reducing muscle tension - there seems to be some temporary, local increase in blood flow to the area being manipulated.
Improving spinal mobility and reducing stiffness - through the neural modulation, most people are likely to experience a temporary improvement in spinal mobility and subjective stiffness. This is the BEST time to get onto your active rehabilitation.
An example of how we perform a lumbar spine (lower back) manipulation.
Why You Shouldn’t Worry About “Specific Levels”
Some practitioners may claim that they are adjusting a very specific vertebra (e.g., L4-L5 or C5-C6) and that precise manipulation at that level is crucial for success. However, research suggests otherwise.
A 2025 study published in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) found that spinal manipulations don’t need to be precisely targeted at a single joint to be effective. The pain relief effects extend beyond the treated area, suggesting that treatment works more globally through neurophysiological responses (neuromodulation) rather than purely mechanical adjustments.
What does this mean for you?
You don’t need to obsess over the exact vertebral level being treated.
Hands-on treatment can provide relief, but it shouldn’t be your only solution.
A structured rehabilitation plan is essential for long-term recovery.
The Missing Link: Why You Need More Than Just Hands-On Treatment
While manual therapy can provide short-term relief, research consistently shows that combining spinal manipulation with active rehabilitation delivers the best long-term results.
At Physiologic HK, we’ve developed the Spinal Solutions Program—a structured 6-week rehabilitation plan designed specifically for back pain sufferers who need more than just passive treatment.
Introducing the Spinal Solutions Program
If you want lasting relief from back pain, the Spinal Solutions Program is the answer. This 6-week structured program is designed to help you:
Reduce pain and stiffness through targeted manual therapy
Regain strength and mobility with individually prescribed exercises
Improve spinal resilience with a progressive gym-based rehab plan
Boost confidence in your movement so you can return to the activities you love
This program is not just about short-term relief—it’s a comprehensive rehabilitation plan that helps you take control of your recovery. Whether you're dealing with chronic lower back pain, sciatica, or postural-related discomfort, our expert physiotherapists will guide you through a combination of:
Hands-on spinal treatment – to alleviate tension and reduce pain
Active rehabilitation – including core stability work, strength training, and movement drills
Education on pain management – to help you understand and manage your condition long-term
An example of a mobility exercise in our Spinal Solutions Program, perfect for those who have desk jobs!
Why Choose Physiologic HK’s Spinal Solutions Program?
At Physiologic HK, we believe in providing more than just quick fixes. The Spinal Solutions Program is built on scientific principles and delivered by experienced physiotherapists who specialize in spinal conditions.
We’ve helped over 135 people since it’s inception to regain control over their spinal health, and we’d love to help you too!
Hands-on care meets active rehabilitation – the perfect blend for long-term success
Fully equipped rehab gym – so you can train safely under expert guidance
Personalized treatment – your program is tailored to your needs and recovery goals
Not sure where to start?
We get it, choosing the right health care provider is daunting. If you’re unsure on how to start, we’d love to hear from you, to help guide you in the right direction, regardless if you decide to work with us or not.
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ABOUT THE AUTHOR
Ryan Tan, the Clinical Director and Spinal Physiotherapist at Physiologic Hong Kong, brings over a decade of expertise in sports and spinal physiotherapy. He holds a Certificate of Spinal Manual Therapy (COSMT), an intensive qualification dedicated to advanced spinal care, as well as being trained in Osteopathic Spinal Manipulations (OMT).
Ryan’s extensive background includes working in renowned Complex Pain Clinics in London, where he specialised in managing complex spinal conditions, working closely with Pain Consultants & Spinal Neurosurgeons.
Here in Hong Kong, he collaborates with leading Orthopaedic Spinal Specialists to deliver comprehensive and effective treatments for individuals suffering from persistent Spinal (Neck and Back) Injuries. If you have a complex spinal injury that remains unresolved, contact us for a thorough and obligation-free assessment!
