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Spinal Manipulation: Then vs Now 15 years ago, manipulation was sold as “putting joints back in place.” 👉 Same techniques. Outdated story. Today, the evidence is clear: ✅ HVLA works through neurophysiological effects (descending pain control, sensorimotor changes) – not bone realignment. ✅ The pop isn’t the point — cavitation ≠ better outcomes. ✅ Benefits are usually short-term, and strongest when combined with exercise, education & load management. Why it matters: As clinicians, we have to: ✔️