Why is the treatment recommended?

The results of previous examinations suggest that your symptoms can be traced back to functional disorders of the postural and musculoskeletal system. The consequences of these disorders can be limited movement and pain, as well as numbness and tingling in the spine, arms, and legs. Disorders of the cervical spine can cause neck pain (“stiff neck”), vision and hearing disturbances, ringing in the ears, swallowing and voice production disorders, sore throat, foreign body sensation, lump and tightness in the throat, sweating, and sleep disturbances. The use of manual medicine is advisable for further clarification and treatment of existing problems.

Manual Medicine

“Manual medicine” means examination and treatment by hand. These manual medical treatments, which are carried out exclusively by properly trained professionals with additional qualifications in “manual medicine,” involve the doctor using their hands as the primary tool. The doctor uses their hands to detect and treat functional disorders (e.g., muscle stiffness, spinal blockages) affecting the interaction of joints, muscles, and nerves.

Insurance Coverage

The costs of manual medicine are not covered by public health insurance, but may be covered by private health insurance. It is advisable to clarify the question of cost reimbursement in advance.

Preliminary Examinations

Before treatment, you will be asked about your symptoms and pains, any existing or accompanying diseases, and you will undergo a manual medicine examination. This is important for the doctor to check which manual medical methods are suitable for you and whether there are any diseases or factors that prevent you from undergoing such treatment (e.g., severe osteoporosis, cancer-related bone weakness: increased risk of fractures due to thin/weakened bones).

In the case of certain existing diseases (e.g., disc herniation, spinal stenosis), the doctor must examine whether the treatment can be carried out or not. Depending on the health condition, it may not be possible to apply certain treatment methods (e.g., sports therapy/muscle strengthening exercises) in cases of advanced symptoms and very strong pain.

During the preliminary examinations, the doctor also evaluates existing images and findings (e.g., ultrasound images, X-rays) – especially if spinal manipulation is planned. If necessary, further examinations using imaging techniques may be ordered to uncover structural damage that is not suitable for manual medicine treatment or contraindicates the treatment.

What treatment methods are available?

Below we briefly introduce the most important manual medical treatment techniques. During the consultation, the doctor will discuss with you which techniques are suitable for treating your complaints and will talk about the advantages and disadvantages of each method, the various risks, and the chances of success.

  • Soft Tissue Techniques: The functional disorders in the arm and leg joints, as well as the spine (e.g., tension, blockage), can be treated by pressing (compression), rubbing, and stretching the soft tissues, such as muscles, fascia (the connective tissue network surrounding the muscles), tendons, and ligaments.
  • Mobilization: To restore or improve the mobility of joints (e.g., vertebral joints, arm and/or leg joints), slow movements are performed repeatedly, with increasing extent and possibly increasing intensity.
  • Manipulation: A small, quick, short, and targeted movement can release joint blockages, such as in the spine, ribs, arm or leg joints area (HVLA, high velocity low amplitude technique).

Especially before manipulating the spine, the doctor first positions the affected body part by properly placing the patient so that the vertebral segments above and below the blocked vertebral segment do not move during the treatment and are protected from the effects of manipulation. Then a diagnostic trial mobilization (trial traction) is performed. The doctor slowly moves the spine to be treated, the rib, or joint area in the direction of the planned quick, short, and targeted movement. If there is no pain, discomfort (e.g., dizziness, vision disturbances, tingling in the arm or leg), or other signs that contraindicate the treatment, then actual manipulation can take place. The therapeutic manipulation is then performed with a targeted, short, quick movement and little force. Most of the time, this is not painful. A brief sensation of pain may occur, but it quickly passes on its own. However, a “cracking” sound is often heard, which is characteristic of the treatment but completely harmless.

  • Neuromuscular Treatment: Under medical supervision, the patient consciously tightens and relaxes certain muscles. The doctor may also perform various muscle stretches. This is used to treat functional disorders of the muscles and joints.

Further Treatment Options

Manual medical treatment is often supported by useful complementary elements, such as physiotherapy, massages, physical therapy (e.g., application of heat or cold, nerve stimulation with electrical stimuli), regular exercises necessary for everyday life, or the use of orthopedic aids. Drug treatment (e.g., administration of painkillers, local anesthetics, or other drugs) might also be considered. These treatments can also offer an alternative if you are reluctant to undergo manual medical treatment.

During the consultation, the doctor will explain to you what other treatment options are available for you and inform you about their benefits and drawbacks, the various risks, and the chances of effectiveness.

Risks and Possible Complications

Despite all precautions, complications that may require further treatment or surgery can occur – including life-threatening ones. The frequency data provide a general assessment and are intended to assist in evaluating the risks. They do not correspond to the definition of side effects listed in the medication package leaflets. The frequency of complications can be significantly influenced by existing and accompanying diseases, as well as individual characteristics. During the consultation, the doctor will inform you about the risks. It applies to all treatments that your existing pains may initially worsen, but should improve after a few hours or a day.

Risks of Manual Medicine on the Arms and/or Legs:

  • Transient discomfort similar to muscle pain may occur. There are no known serious risks associated with the treatment of limbs.

Risks of Manual Medicine Treatment of the Spine:

  • Minor complaints such as headache, nausea, dizziness, and circulatory complaints, as well as muscle pain (e.g., in the neck, shoulder, or the area of the treated vertebral joints), are possible after the treatment.
  • If pressure is applied to the ribs, very rare cases of rib fractures can occur, which can cause pain but generally heal on their own with rest, as the ribs stabilize each other.

Special Risks of Spinal Manipulation:

  • If an unknown disc herniation or other previous injury exists, spinal manipulation can worsen the condition and damage the nerve roots. This can cause transient, very rarely permanent, pain, discomfort, and movement disorders, or even paralysis in the shoulders, arms, or legs.
  • Despite all care, cervical spine manipulation can very rarely lead to damage to the vessels supplying the brain:
  • Tears in the wall of the cervical arteries (carotid arteries) that exist before manipulation can widen due to the manipulation.
  • The tear can very rarely be caused by the manipulation itself but only if there is a predisposition, weakness, or disease of the vessels (e.g., inflammatory changes in the vessel wall). Such tears can also be caused by everyday stress or sudden movements in these cases.
  • Tears can lead to the risk of blood clots (emboli) breaking off and blocking the vessel. This can have serious, possibly life-threatening consequences (e.g., stroke, brain damage, permanent paralysis).

Other serious complications, such as those affecting the bones or ligaments, spinal cord, or nerve roots, occur very rarely during manual medical treatment. The doctor will recommend the treatment only if the expected success clearly outweighs the risks.

Chances of Effectiveness

The success of the treatment depends on various factors (e.g., the cause of the complaints, previous diseases) and, as with any treatment, cannot be guaranteed.

With manual medicine, it is often possible to determine the type and extent of functional disorders, release muscle stiffness or blockages, alleviate pain, and improve mobility. However, the cause of the symptoms cannot always be eliminated. In individual cases, a temporary worsening of symptoms cannot be ruled out. Furthermore, functional disorders (e.g., blockages) may recur. The doctor will discuss with you the chances of success of the proposed treatment for you and what you need to contribute to the success.

Your cooperation is very important for the success of the treatment, especially in the case of supportive measures such as physiotherapy, exercises to be done at home, and specific behavioral rules (e.g., avoiding incorrect posture and excessive strain).


Before the treatment, please inform your treating doctor about any medication (including herbal or over-the-counter medicines) you are currently taking, especially anticoagulant medications (e.g., Marcumar®, Aspirin, Plavix®, Iscover®, Pradaxa®, Xarelto®, Eliquis®, etc.) and, in the case of diabetics, medications containing metformin. Medications should only be taken or discontinued after consulting with a doctor.

Please hand over important documents, such as IDs/certificates (allergies, Marcumar, diabetes, implants, etc.), findings, and images – if available.

After the Treatment

If symptoms such as pain, discomfort, movement disorders, persistent dizziness, or unusual fatigue occur after the treatment, please seek medical attention immediately! A temporary increase in existing symptoms, lasting from a few hours to a day, is possible and harmless.

After treatment of the cervical spine, you may only leave the clinic approximately 15 minutes later if you are sure you feel well. If you experience temporary dizziness in the first few minutes after the treatment, you should not participate actively in road traffic (neither as a driver, cyclist, nor as a pedestrian) for about 1 hour!

Please be sure to follow the behavioral rules provided (e.g., exercises that can be done at home, avoiding improper posture and excessive strain on the spine, permitted sports). In addition, manual therapy is often supplemented with other treatments, such as physical therapy, medication for pain relief, or spine training. Your doctor will tell you which measures are suitable for you.