@dlydailyhope Perhaps my answer needs more context. My PT was not doing spinal manipulation; she was just feeling with her hands to feel if the spinal processes were aligned. She was doing myofascial release to release the muscular tension and muscle spasms. She also did neuro-stimulation on nerve roots to block pain signals. Because the muscles can pull the vertebrae out of alignment during a muscle spasm, releasing that with her hands allows them to return to a more normal alignment. Her work was similar to massage of the muscles. The doctor did MR imaging and my PT required that before working on my neck. It is important to rule out spinal instability because that can be serious and lead to spinal cord damage and PT would not be advised.

With the degree of cervical canal stenosis that I had, it had not caused visible damage to my spinal cord on imaging, but I did have intermittent symptoms when my neck was out of alignment and was more straight with the loss of the lordotic curve. My PT was able to get the lordotic curve back except where the collapsed C5/C6 disc was and this relieved some pain symptoms because it took pressure off by getting closer to normal alignment. If I had instability, she would not be doing PT, and I would have been ushered to surgery. Actually, it was the opposite, I was trying to get a surgical fix, and no surgeon would help because I had pain symptoms all over my body that they did not understand. My therapist was buying me some time and slowing the progression of symptoms before surgery. It actually took 2 years of PT and surgical consultations before I had an offer for surgical help. In my answer to @rico2 , I presumed that the surgeon would have done imaging before writing orders for PT.

My PT advised against chiropractic type manipulations. If PT is making symptoms worse, the surgeon should be told about it. I know there are patients where MR imaging would be different in a laying down position vs sitting or standing because of vertebrae shifting. My spine had not advanced that far, and PT did help temporarily until the next muscle spasm. PT prevented further damage, and insured the success of my decompression spine surgery. Every case is different, so what worked for me may not be the answer for someone else. I was trying to explain the connection between aggravation of symptoms and physical alignment changes that provided evidence that cervical cord compression was causing the problems and body wide pain. I was amazed that 5 surgeons missed that connection, didn't understand why, and wouldn't help. That was what brought me to Mayo to a surgeon who did understand this phenomenon called funicular pain. My PT had a doctorate and she was a great source of knowledge about spine surgery and rehab after spine surgery.