Spinal manipulation is a therapeutic intervention performed on spinal articulations which are
synovial joints. These articulations in the spine that are amenable to spinal manipulative therapy include the
z-joints, the
atlanto-occipital,
atlanto-axial,
lumbosacral,
sacroiliac,
costotransverse and
costovertebral joints. National guidelines come to different conclusions with respect to spinal manipulation with some not recommending it, some describing manipulation as optional, and others recommending a short course in those who do not improve with other treatments.