by Alan Jordan
Spinal manipulation has been practised by doctors since the time of Hippocrates. It was taught systematically to chiropractors and osteopaths for the past 100 years or so and during the past 20-30 years it has become more common for specially trained physiotherapists to carry out spinal manipulations as well.
Spinal manipulation for lower back pain been shown to be effective, safe and cost-effective. Indeed, it is reasonable to state that spinal manipulation has become part of mainstream medicine and is practised in both the public and independent sectors in most western countries.
Chiropractors often refer to manipulation of a spinal joint as an ‘adjustment‘. Following the labelling system developed by Geoffery Maitland, manipulation is synonymous with Grade V mobilization. Because of its distinct biomechanics, the term high velocity low amplitude (HVLA) thrust is often used interchangeably with manipulation, as opposed to mobilisation.
So, how does it work?
The effects of spinal manipulation have been shown to include:
- Temporary relief of musculoskeletal pain.
- Shortened time to recover from acute lower back pain.
- Temporary increase in passive range of motion.
- Physiological effects on the central nervous system, probably at the segmental level.
- Altered sensorimotor integration similar to acupuncture.
Spinal manipulation has been shown to result in an immediate post treatment increase in range of motion, decreased adjacent soft tissue tenderness, improved function and decreased pain.
Although the exact mechanism is not clear, current models that explain the treatment benefits appreciated following spinal manipulative therapy (SMT) include: motion segment unbuckling, meniscoid inclusion release, intra-articular adhesion / fringe release, stimulation of joint mechanoreceptors and/or relaxation of hypertonic muscle. Centrally mediated reflexes are being investigated.
Common side effects of spinal manipulation are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort. Manipulation should only be carried out by authorised practitioners and only after a thorough interview and physical examination.
At Broadgate Spine & Joint Clinic, we have many practitioners who employ spinal manipulation as part of their treatment. These include chiropractors, osteopaths, and physiotherapists. Additionally, there are several physicians on staff to prescribe medication if needed. If appropriate patients are then sent on to rehabilitation in order to prevent re-injury to the region involved.
You can find out more about Dr Alan Jordan, the author of this article and a director at Broadgate, here.