A licensed massage therapist (LMT) is not permitted to perform a high-velocity spinal adjustment, commonly referred to as “cracking the back.” Spinal manipulation is a specialized procedure that falls outside the legal and professional scope of practice for massage therapy. LMT training focuses on the body’s soft tissues, and attempting a skeletal adjustment can be hazardous. Individuals seeking a spinal adjustment should consult a healthcare provider whose license specifically covers this treatment.
Defining the Scope of Massage Therapy
The professional boundaries of a licensed massage therapist are strictly regulated by state and provincial boards, defining the scope of practice and limiting the techniques an LMT is legally allowed to perform. Massage therapy is fundamentally centered on the manual manipulation of soft tissues, including muscles, tendons, ligaments, and fascia. The primary goal is to relieve muscle tension, improve circulation, enhance mobility, and promote relaxation.
LMT training emphasizes anatomy, physiology, and kinesiology related to soft tissues. This training does not include the extensive diagnostic skills or specialized techniques required for safe spinal adjustments. An LMT who attempts a spinal adjustment practices outside their professional license, risking serious legal and ethical consequences. This boundary protects the client by ensuring procedures requiring advanced skeletal knowledge are performed only by appropriately licensed professionals.
Spinal Manipulation vs. Soft Tissue Mobilization
The distinction between massage therapy and spinal adjustment lies in the technique’s speed and amplitude. What the public calls “cracking” is technically known as High-Velocity Low-Amplitude (HVLA) thrust. This technique involves a rapid, short thrust delivered to a joint, briefly separating the articular surfaces and sometimes producing a popping sound called cavitation.
In contrast, a massage therapist uses soft tissue mobilization and joint articulation, which are Low-Velocity Low-Amplitude (LVLA) movements. These are slower, more sustained, and controlled movements that stretch or move a joint within its passive range of motion. Mobilization is a gentler approach that rarely results in cavitation and allows the patient to resist the movement. The goal of mobilization is to improve joint function, reduce stiffness, and relieve pain through controlled, rhythmical movement. The HVLA thrust requires specific training in biomechanics to apply the precise force and direction needed for a safe adjustment.
Professionals Licensed for Spinal Adjustments
Spinal manipulation is reserved for licensed healthcare providers with extensive, specialized training in differential diagnosis and skeletal treatment. The most recognized professional authorized to perform spinal adjustments is the Doctor of Chiropractic (DC). Chiropractors complete years of professional study, including thousands of hours of training in the musculoskeletal system, nerve function, and controlled force application.
Other licensed providers whose scope of practice may include spinal manipulation are Doctors of Osteopathic Medicine (DOs), who practice Osteopathic Manipulative Treatment (OMT). Specific Physical Therapists (PTs) with advanced manual therapy training may also be authorized, depending on the jurisdiction. These professionals assess the patient’s condition, including medical history and physical examinations, before determining the adjustment’s appropriateness. Their extensive education ensures they can accurately diagnose the issue and identify contraindications, such as osteoporosis or spinal instability, that would make manipulation unsafe. This diagnostic step is a crucial prerequisite for a safe adjustment and falls outside the purview of a massage therapist.
Risks of Untrained Spinal Manipulation
Attempting a spinal adjustment without proper diagnostic training and technical skill carries substantial risks. The delicate nature of the spine, which houses the spinal cord and major blood vessels, means mishandling can lead to serious injury. Untrained manipulation can cause immediate consequences like muscle strains, ligament sprains, and potential damage to spinal discs, such as a herniation or rupture. More severe, though rare, complications include nerve damage resulting in chronic pain or weakness, and even fractures. A particularly serious risk associated with forceful neck manipulation is vertebral artery dissection. This occurs when a tear in the artery wall leads to clot formation and can result in a life-threatening ischemic stroke, especially in younger patients. The lack of a thorough pre-adjustment evaluation by an untrained individual significantly elevates the chances of these adverse outcomes.