Many patients with low back pain and other spinal related disorders benefits from the skilled application of spinal manipulative procedures, especially in the early stages of pathology, the phase of dysfunction. Joint dysfunction is a departure from normal and ideal joint movement thus causing pain, muscle splinting and increased joint wear and tear. Spinal manipulation corrects this mechanical dysfunction and renormalizes joint mobility.
What is Spinal Manipulation?
Spinal manipulation is defined as a skilled, passive manual therapeutic maneuver during which a synovial joint is carried beyond the normal physiological range of motion without exceeding the boundaries of anatomical integrity. The manipulation is carried by way of a brief, shallow, sudden and carefully administered thrust directed to a dysfunctional spinal segment at the limit of the paraphysiological zone of joint motion. The procedure is usually accompanied by a cracking sound that is termed the Cavitation Phenomenon. This is a distractive maneuver on a spinal segment liberating a gas bubble that is 80% CO2.
Particularly confusing are the differences between “mobilization” and “manipulation. Mobilization carries joint mobility through the active range of motion to the passive ranges of motion without going through the elastic barrier that leads to the paraphysiological zone. In contrast, manipulation carries a joint beyond the passive range of motion through the elastic barrier and within the paraphysiological space with immediate direct effect to the autonomic nervous system. Both skilled procedures are considered safe and effective, although manipulation is established as superior towards the relief of mechanical back pain.
The evidence supporting Spinal Manipulation
Spinal manipulation as a treatment for spinal pain has a long tradition dating back to antiquity; yet full acceptance of this method of treatment has yet not occurred. There have been 36 controlled trial studies of manipulation for lower back pain. Spinal manipulation has been subjected to more controlled trials than any other form of treatment and has been established as a first line treatment for mechanical back pain.
The strongest support for the inclusion of spinal manipulation in the first-line approach to the treatment of back pain is shown in the recent clinical guidelines established in North America and in Europe. These guidelines, which were developed by analyzing the published research, clearly recommend spinal manipulation as the treatment of choice for many patients with acute, uncomplicated back pain.
Over the years, spinal manipulation has been subjected to considerable scrutiny of its clinical effectiveness and cost effectiveness as a treatment for spine pain, to the point that spinal manipulation is now the most studied intervention for this condition. All this study has led to the conclusion that spinal manipulation is an effective and safe treatment for spine pain of mechanical origin.
The therapeutic effect of Spinal Manipulation
The therapeutic effect of spinal manipulation are explained in terms of mechanical (physical) and neurophysiological (reflex) mechanisms. Basically, the physical effects of manipulation involve:
- Joint cavitation (crack sound) stems from within the joint and does not correlate with the effectiveness of the treatment.
- Increase in active and passive ranges of motion
- Breaking of interarticular adhesions
- Joint and muscular mechanoreceptor stimulation.
The neurophysiological reflex effects include:
- Inhibition of pain by afferent impulses to the central nervous system
- Relaxation of muscle by inhibiting motor neurons
- Stimulation of the autonomic nervous system
How to find a skilled practitioner of Spinal Manipulation
Most of the spinal manipulative therapy in North America is delivered by chiropractors. Spinal manipulation is the treatment that most people associate with chiropractors. Chiropractors, in their undergraduate training, concentrate on spinal manipulation and develop a degree of expertise that is only learned to a limited degree at the post-graduate level by other health care providers.