Spinal Manipulation / Spinal Adjustments
Spinal manipulation is a skilled, hands-on technique used to restore joint motion, reduce muscle guarding, and improve overall movement quality. At Osteopractic Physical Therapy of the Carolinas, spinal manipulation is performed by a Doctor of Physical Therapy with advanced training and is always integrated into a comprehensive treatment plan — never applied as a one-size-fits-all approach. These adjustments are safe, comfortable and highly effective when administered by experienced clinicians. Dr. Zacharko and Dr. Smith are both highly trained in performing these treatments. Dr. Zacharko serves as a Senior Instructor for the American Academy of Manipulative Therapy’s Spinal Manipulation Institute and travels internationally teaching SMT to other healthcare providers (PT’s, Chiropractors, MD’s, DO’s, NP’s, ATC’s) and lecturing on the research surrounding the topic. Dr. Zacharko has been teaching and practicing SMT in his clinic for over 15 years and is considered one of the most skilled providers of SMT nationally.
Patients often seek spinal manipulation when they feel stiff, restricted, or “locked up,” or when other treatments have not fully addressed their symptoms.
What Is Spinal Manipulation?
Spinal manipulation is a manual therapy technique involving a controlled, high-velocity, low-amplitude movement applied to a specific joint of the spine.
When used appropriately, spinal manipulation can:
Improve joint mobility
Reduce protective muscle tightness
Improve movement efficiency
Decrease pain associated with joint restriction
The goal is not simply to “crack” the spine, but to restore normal joint motion so surrounding muscles and nerves can function properly.
When Is Spinal Manipulation Used in Physical Therapy?
Spinal manipulation may be used when joint restriction is contributing to pain or movement limitation, including:
Neck pain or stiffness
Low back pain
Upper or mid-back tightness
Chronic muscle tightness with normal imaging
Movement restrictions that limit daily activity or exercise
Spinal manipulation is not required for every patient and is only used when clinically appropriate.
How OPTC Uses Spinal Manipulation Differently
At OPTC, spinal manipulation is:
Performed only after a thorough evaluation
Used as part of a larger treatment plan
Combined with manual therapy, soft tissue work, and movement retraining
Tailored to the individual — not applied by routine
Manipulation is one tool among many, used to help changes last, not just feel good temporarily.
Is Spinal Manipulation Safe?
Yes — when performed by a Doctor of Physical Therapy with advanced training, spinal manipulation is safe and well supported by research.
At Osteopractic Physical Therapy of the Carolinas:
All patients are carefully screened
Red flags and contraindications are ruled out
Techniques are modified based on comfort and presentation
Informed consent is always obtained
Patient safety and clinical reasoning come first.
What Does a Spinal Manipulation Session Feel Like?
Patients commonly report:
A feeling of improved motion or “release”
Reduced stiffness shortly after treatment
Mild soreness similar to exercise, which resolves quickly
Not all manipulations produce an audible sound, and sound alone does not determine effectiveness.
Conditions That Often Benefit From Spinal Manipulation
Spinal manipulation is frequently used as part of treatment for:
Neck Pain & Headaches
Low Back Pain
Chronic Muscle Tightness
Upper and mid-back stiffness
View the full list of conditions we treat
Not Sure If Spinal Manipulation Is Right for You?
Spinal manipulation is just one part of effective care. Identifying why your symptoms are occurring is the most important step. Our doctors are happy to discuss this treatment option with you and how it can be included in your plan of care. We do allow for “SMT only” visits but the patient will need to be an established patient with the OPTC by first having undergone a comprehensive initial evaluation.