Chiropractic or manual therapy — which to choose near Rybnik?

Chiropractic and manual therapy use similar techniques, including spinal manipulation, but in Poland chiropractic is not a regulated profession, while manual therapy is provided by a physiotherapist with a licence to practise. If you are looking for help with back pain near Rybnik, choose a physiotherapist who will assess you before any HVLA manipulation, rule out contraindications and combine the therapy with exercise.

Below we explain what chiropractic is, what manual therapy is, what the HVLA technique involves, when manipulation is not appropriate and how to get to the clinic in Rydułtowy from Rybnik.

Contents

What is chiropractic and what is its status in Poland?

Chiropractic is a field founded in 1895 in the USA, focused on diagnosing and treating disorders of the musculoskeletal system, mainly the spine, primarily through manipulation. In Poland it is not a medical profession regulated by law: there are no chiropractic degree programmes, no register and no professional self-governing body, so the title “chiropractor” on its own says nothing about a person’s qualifications.

In some countries, including the USA, Canada and the United Kingdom, chiropractic is a regulated profession, with several years of university study and a licence. In Poland, people using this title have very different training – from degrees obtained abroad to short courses. Part of the chiropractic tradition is based on the concept of “vertebral subluxation” as the cause of many diseases, which is not supported by scientific research; many modern chiropractors are moving away from this model.

What is manual therapy in physiotherapy?

Manual therapy is part of physiotherapy in which the physiotherapist assesses and treats musculoskeletal problems with their hands: mobilising joints, working on muscles and fascia, and, when the assessment justifies it, performing HVLA manipulation. In Poland it is provided by a physiotherapist – a member of a medical profession regulated by the 2015 Act, with a licence to practise number and professional accountability.

A physiotherapist’s licence to practise number (PWZFz) can be checked in the public register of the National Chamber of Physiotherapists (Krajowa Izba Fizjoterapeutów). At the “W zdrowym ciele” clinic, manual therapy is provided by physiotherapists with certificates including manual therapy according to the German school, the McKenzie method, Cyriax orthopaedic medicine and HVLA techniques . We write more about the method itself in our article manual therapy — what it involves and when it helps.

How does chiropractic differ from manual therapy?

The most important differences concern legal regulation, the scope of the assessment and what happens beyond the technique itself. A physiotherapist works within a medical profession, carries out a differential assessment, treats manipulation as one of several possible techniques and combines it with exercise. In chiropractic, the training of practitioners in Poland varies widely, and manipulation is often the main tool.

Criterion	Chiropractic (in Poland)	Manual therapy (physiotherapist)
Legal status	no statutory regulation	medical profession, Act of 25.09.2015, PWZFz licence number
Education	varied – from degrees abroad to short courses	physiotherapy degree + manual therapy courses
Assessment before treatment	depends on the practitioner	history including red flags, movement and neurological examination, screening tests
Main techniques	manipulations, often as the primary tool	mobilisations, soft tissue work, nerve mobilisations, HVLA only when indicated
Exercise and education	varies	a standard part of therapy
Professional oversight	no professional self-governing body in Poland	National Chamber of Physiotherapists, professional accountability
Price	depends on the practice	at the “W zdrowym ciele” clinic: 180 PLN

The “W zdrowym ciele” clinic does not provide chiropractic services – it is staffed by physiotherapists who use manual techniques as part of physiotherapy.

What are HVLA techniques and when are they used?

HVLA (high velocity, low amplitude) is a manipulation, i.e. a quick, short thrust with a small range, directed at one segment of the spine or a specific joint, e.g. a rib joint or the sacroiliac joint. At the “W zdrowym ciele” clinic, the physiotherapist uses it only after taking a history and carrying out an assessment, when there are no contraindications, and always as part of broader therapy with mobilisations and exercise.

The process usually looks like this: assessment, preparing the tissues with gentler techniques, positioning the patient, a controlled thrust and re-assessing movement. HVLA is considered, among other things, for restricted mobility of a spinal segment, neck and back pain without red-flag symptoms, headache originating from the neck and rib joint problems. Research reviews indicate that for low back pain, manipulation gives a small to moderate improvement, similar to other recommended methods.

Manual therapyfor back and neck pain and restricted joint mobility, including HVLA techniques after an assessment180 PLN

When is spinal manipulation not appropriate?

HVLA manipulation is not performed after a recent injury or when a fracture is suspected, with advanced osteoporosis, cancer or bone metastases, infection or acute joint inflammation, spinal instability, signs of pressure on the spinal cord or nerve roots with increasing weakness, or when disease of the neck arteries is suspected. Caution is needed with anticoagulant (blood-thinning) medicines and after previous spinal surgery.

The list is for guidance only – safety is determined by the history and assessment. When manipulation is not appropriate, the physiotherapist chooses gentler techniques, e.g. mobilisations, soft tissue work or exercises based on the McKenzie method, or refers you to a doctor for further investigation.

How to get to manual therapy from Rybnik?

The “W zdrowym ciele” clinic is located in Rydułtowy at ul. Strzelców Bytomskich 11, in the Health Centre building (Ośrodek Zdrowia), about 10 km from the centre of Rybnik. There is a large car park by the building, and a lift takes you to the clinic on the 1st floor. The clinic is open Monday to Friday from 7:00 to 20:00, and visits can be booked by phone or via Booksy.

We try to offer consultation appointments as soon as possible. For patients who cannot travel, we offer home physiotherapy within 15 km of Rydułtowy, including in Rybnik; the physiotherapist decides which techniques are possible at home after the assessment . You will find a map and directions on the contact page.

Summary

In Poland chiropractic is not a regulated profession, while manual therapy, including HVLA techniques, is provided by a physiotherapist with a PWZFz number – after an assessment, with contraindications ruled out and combined with exercise. The “W zdrowym ciele” clinic is in Rydułtowy, about 10 km from the centre of Rybnik; manual therapy costs 180 PLN.

Frequently asked questions

Does a “crack” mean the vertebra has gone back into place?

No. The sound during a manipulation occurs when the pressure in the joint fluid drops suddenly and a gas bubble forms. It does not mean a vertebra has been “put back”, because with typical back pain vertebrae do not “slip out” of place. No sound does not mean the treatment failed either, and mobilisations work entirely without it.

Is neck (cervical spine) manipulation safe?

Serious complications of neck manipulation, e.g. damage to an artery, are very rare but possible. That is why, before treatment, the physiotherapist takes a history focusing on vascular disease and neurological symptoms, in line with the international IFOMPT recommendations. If there is any doubt, they choose gentler techniques, e.g. mobilisations or exercises, which can also reduce neck pain.

Does HVLA manipulation hurt?

Usually not. The patient feels a short, quick movement and sometimes hears a characteristic sound. After treatment there may be temporary tenderness or a feeling of muscle tiredness, similar to how you feel after exercise. Pain while simply being positioned for the technique is a signal to abandon it and choose another, gentler way of working.

Can I refuse manipulation?

Yes. Every technique requires your consent, and the physiotherapist should explain what they intend to do and why. If you do not want manipulation, there are gentler techniques with a similar aim, e.g. joint mobilisations, soft tissue work or exercises based on the McKenzie method. Declining manipulation does not rule out further therapy.

How many manual therapy visits are needed for back pain?

The physiotherapist decides on the number of visits individually after the consultation. It depends on the type and duration of the problem, the assessment findings, the response to the first techniques and how regularly you exercise at home. After each visit the change in pain and movement is assessed, and if there is no improvement, the plan is changed or the patient is referred to a doctor.

Do I need a referral for manual therapy?

No. You don’t need a referral for a private visit to the “W zdrowym ciele” clinic in Rydułtowy, and the clinic has no contract with the NFZ. It is worth bringing your imaging results, e.g. X-ray or MRI, a list of your medicines and information about any past operations. If the assessment shows the need, the physiotherapist will recommend a medical consultation.

Sources

• Act of 25 September 2015 on the profession of physiotherapist (Journal of Laws – Dz.U. 2015 item 1994, as amended).
• NICE, Low back pain and sciatica in over 16s: assessment and management (NG59), 2016, updated 2020.
• Paige N.M. et al., Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain, JAMA, 2017;317(14):1451–1460.
• Rubinstein S.M. et al., Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials, BMJ, 2019;364:l689.
• Rushton A. et al., International Framework for Examination of the Cervical Region for Potential of Vascular Pathologies of the Neck Prior to Musculoskeletal Intervention: International IFOMPT Cervical Framework, JOSPT, 2023;53(1):7–22.