Efek terapi manual melibatkan sistem supraspinal karena menyebabkan eksitasi sistem saraf simpatis (berupa perubahan tekanan darah dan [[aliran darah]] pada [[kulit]])<ref>{{Cite web|title=Assessment of skin blood flow following spinal manual therapy: a systematic review. - PDF Download Free|url=https://docksci.com/assessment-of-skin-blood-flow-following-spinal-manual-therapy-a-systematic-revie_5a8e5125d64ab2fa510bbbbe.html|website=docksci.com|language=|access-date=22 Februari 2022}}</ref> yang menghasilkan hipoalgesia (penurunan ambang nyeri sebagai respons terhadap stimulus standar).<ref>{{Cite bookjournal|last=Kingston|first=Laura|last2=Claydon|first2=Leica|last3=Tumilty|first3=Steve|last4=|first4=|date=1 Agustus 2014|url=https://www.ncbi.nlm.nih.gov/books/NBK242088/|title=The effectsEffects ofOf spinalSpinal mobilizationsMobilizations onOn theThe sympatheticSympathetic nervousNervous systemSystem: aA systematicSystematic reviewReview|publisherurl=Centre for Reviews and Dissemination (UK)https://www.researchgate.net/publication/261674184_The_Effects_Of_Spinal_Mobilizations_On_The_Sympathetic_Nervous_System_A_Systematic_Review|pagesjournal=281-287Manual Therapy|languagevolume=19|doi=10.1016/j.math.2014.04.004|pmid=24814903|url-status=live}}</ref> Selain itu terdapat penurunan denyut jantung sebagai respons terhadap berkurangnya perasaan [[stres]],<ref name=":8">{{Cite journalweb|last=LindgrenNiaz|first=L.Mehwish|last2title=RundgrenEffect of Spinal Manual Therapy on Blood Pressure and Heart Rate in Upper Back Pain|first2url=Shttps://www.|last3=Winsö|first3=Oomicsonline.org/open-access/effect-of-spinal-manual-therapy-on-blood-pressure-and-heart-rate-inupper-back-pain.pdf|last4=Lehtipalo|first4website=Swww.omicsonline.org|last5access-date=Wiklund24 Februari 2022}}</ref><ref>{{Cite journal|first5last=U.Win|last6first=KarlssonNi Ni|first6last2=M.Jorgensen|last7first2=Stenlund|first7=HAnna Maria S.|last8last3=JacobssonChen|first8first3=C.Yu Sui|last9last4=BrulinHaneline|first9first4=CMichael T.|date=8Maret Desember 20102015|title=PhysiologicalEffects responsesof Upper and Lower Cervical Spinal Manipulative Therapy on Blood Pressure and toHeart touchRate massageVariability in healthyVolunteers volunteersand Patients With Neck Pain: A Randomized Controlled, Cross-Over, Preliminary Study|url=https://pubmedwww.ncbi.nlm.nih.gov/20638912pmc/articles/PMC4371115/|journal=AutonomicJournal Neuroscience:of Basic &Chiropractic ClinicalMedicine|volume=15814|issue=1-2|pages=105–1101–9|doi=10.1016/j.autneujcm.20102014.0612.011005|issn=18721556-74843707|pmc=4371115|pmid=2063891226693212}}</ref> menurunnya kadar enzim amilase saliva,<ref>{{Cite journal|last=Ogura|first=Takeshi|last2=Tashiro|first2=Manabu|last3=Masud|first3=Mehedi|last4=Watanuki|first4=Shoichi|last5=Shibuya|first5=Katsuhiko|last6=Yamaguchi|first6=Keiichiro|last7=Itoh|first7=Masatoshi|last8=Fukuda|first8=Hiroshi|last9=Yanai|first9=Kazuhiko|date=1 November 2011|title=Cerebral metabolic changes in men after chiropractic spinal manipulation for neck pain|url=https://www.researchgate.net/publication/221814921_Cerebral_metabolic_changes_in_men_after_chiropractic_spinal_manipulation_for_neck_pain|journal=Alternative therapies in health and medicine|volume=17|pages=12–7}}</ref> dan penurunan kadar kortisol dan insulin dalam saliva.<ref>{{Cite namejournal|last="Tuchin|first=Peter J.|date=1998-07|title=The effect of chiropractic spinal manipulative therapy on salivary cortisol levels|url=https:8"//www.ncbi.nlm.nih.gov/pmc/articles/PMC2050804/|journal=Australasian Chiropractic & Osteopathy|volume=7|issue=2|pages=86–92|issn=1328-0384|pmc=2050804|pmid=17987159}}</ref><ref>{{Cite journal|last=Rahman|first=Md Shafiqur|last2=Zhao|first2=Xuan|last3=Liu|first3=Jia Jia|last4=Torres|first4=Enid Quintana|last5=Tibert|first5=Babylonia|last6=Kumar|first6=Parvin|last7=Kaldo|first7=Viktor|last8=Lindefors|first8=Nils|last9=Forsell|first9=Yvonne|date=2018|title=Exercise Reduces Salivary Morning Cortisol Levels in Patients with Depression|url=https://www.karger.com/Article/FullText/494699|journal=Complex Psychiatry|language=english|volume=4|issue=4|pages=196–203|doi=10.1159/000494699|issn=2673-3005|pmid=30815455}}</ref> Efek hipoalgesia ini dapat bertahan hingga 24 jam setelah terapi manual dilakukan.<ref>{{Cite journal|last=Hegedus|first=Eric J|last2=Goode|first2=Adam|last3=Butler|first3=Robert J|last4=Slaven|first4=Emily|date=Agustus 2011|title=The neurophysiological effects of a single session of spinal joint mobilization: does the effect last?|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143008/|journal=The Journal of Manual & Manipulative Therapy|volume=19|issue=3|pages=143–151|doi=10.1179/2042618611Y.0000000003|issn=1066-9817|pmc=3143008|pmid=22851877}}</ref>
Selain membuktikan efek spinal terapi manual, Krisztina Malisza juga berhasil menunjukkan efek supraspinal pada penelitian yang sama. Malisza menemukan adanya respons pada tikus coba berupa penurunan aktivitas supraspinal yang bertanggung jawab untuk proses nyeri.<ref name=":12" />
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* Keluhan baru timbul
* Tidak ada [[Nyeri radikular|gejala radikular]]<ref>{{Cite web|title=The Difference Between Radiculopathy, Radiculitis, and Radicular|url=https://www.verywellhealth.com/what-is-radiculopathy-radiculitis-radicular-pain-4164339|website=Verywell Health|language=|access-date=23 Februari 2022}}</ref> atau gejala alih ([[nyeri alih]])<ref>{{Cite web|title=Referred Pain|url=https://www.physio-pedia.com/Referred_Pain|website=Physiopedia|language=|access-date=23 Februari 2022}}</ref> pada seperempat bagian atas tubuh (servikal, torakal bagian atas, dan tungkai atas)<ref>{{Cite web|last=|first=|date=21 April 2019|title=Upper Quarter Screen|url=https://musculoskeletalkey.com/upper-quarter-screen/|website=Musculoskeletal Key|access-date=23 Februari 2022}}</ref>
* Keterbatasan ROM atau lingkup gerak sendi (kemampuan sendi untuk bergerak sesuai dengan kapasitas maksimumnya)<ref>{{Cite web|title=Range of Motion|url=https://www.physio-pedia.com/Range_of_Motion|website=Physiopedia|language=|access-date=23 Februari 2022}}</ref> dengan rotasi dan atau terdapat diskrepansi saat menunduk
* Tidak ada tanda kompresi [[serabut saraf]] atau periferalisasi<ref name=":10">{{Cite web|last=Kosmahl|first=Edmund M.|title=Centralization and Peripheralization|url=https://www.scranton.edu/faculty/kosmahl/courses/ortho/lab-tech/centralization-and-peripheralization%20.shtml#:~:text=Centralization%20means%20pain%20moves%20up,the%20center%20of%20the%20spine.&text=Peripheralization%20means%20pain%20moves%20laterally,and/or%20down%20the%20extremity.|website=www.scranton.edu|access-date=23 Februari 2022}}</ref> gejala di seperempat bagian atas tubuh pada pemeriksaan lingkup gerak sendi bagian servikal
