Many back specialists, such as chiropractors and osteopaths, believe that many patients experience back pain because of dislocations to joints within the spine that may or may not be seen by radiographic tests. There are a variety of joints that hold the elements of the spine together, and connect to other structures in the pelvic cavity, thoracic cavity, and the base of the skull. Some of these joints and articulations associated with the spine include the costovertebral, costotranverse, sacroiliac, lumbosacral, atlanto-axial, and atlanto-occipital joints, and the Z-joints. These joints facilitate the dual role of moving the spine and protecting the spinal cord. Due to medical conditions, trauma, poor posture and excessive stretching of the spinal ligaments, these synovial joints may become dislocated to the point that these changes are apparent on X-ray and MRI radiographs. Chiropractors and Osteopaths are educated and trained to use their hands and eyes to recognize more subtle dislocations of the spine that aren't likely to be seen on medical images. These subtle Dislocations of the spine joints are known as vertebral subluxations. These specialists believe that through spinal manipulation, dislocations in the spine may be resolved to restore its full functioning and back pain relief.
Spinal manipulation has been recorded as a treatment for various pain conditions in ancient medical texts and medical scholars, including early Egyptian doctors and Hippocrates. These types of treatments fell out of favor in modern medicine, until re-emerged in the late 19th century in North America with the introduction of chiropractic and osteopathic medicine. But it wasn't until the 1960s that spinal manipulative therapy became a mainstream health science. Today, spinal manipulation is still provided by these types of health professionals as well as physical therapists, occupational therapists, and other physiotherapists.
Spinal manipulations typically involve therapists using their hands and body to manually manipulate to spine to eliminate structural instabilities. These are non-surgical treatments for spine conditions. Other names for spinal manipulation are "adjustment" and "mobilization." These treatments typically involve gently guiding patients into a certain position before the specialist performs a high velocity thrust to pop, shift, and push the joints back into their correct alignment. These high velocity maneuvers are also called high velocity low amplitude (HVLA) thrusts. HVLA thrusts are those movements where the patient often hears an audible crack in the part of the body being manipulated.
These types of treatments are not used in emergency medicine, such as in cases where the patients arrive in emergency rooms following car accidents or severe falls.
Kinetics and Kinematics: There are 3-4 phases of these techniques that terminate in the adjustment of the spinal joints:
- Orientation Phase (The patient is turned or orientated into position in preparation for the pre-thrust phase)
- Preload or pre-thrust phase
- Thrust phase
- Resolution phase
Clinical Benefits: These treatments have been shown to not only relieve pain in the spinal joints, but also to increase a patient's range of motion in their body. These treatments decrease the time it takes patients to recover from acute back pain conditions and provides relief from other types of musculoskeletal pain. Patients usually discover an improved passive range of motion (ROM) following their adjustments. This treatment also has been shown to benefit patients with subacute back pain conditions, which involves symptoms lasting from 1-3 months. Manipulation has also been shown to help patients with chronic back pain conditions - with improvements in both pain levels and improvements in function.
The clinical benefits mentioned above are enhanced when spinal manipulation is combined with back exercises and stretching. Without the back exercises and stretching, it is likely that the weakness and stiffness of the muscles that allowed the joints to be dislodged out of place will eventually cause the same problems as before.
Back conditions that have been shown to respond well to spinal manipulation include radiculopathy, sciatica, radiating leg pain, and lower back pain.
Side Effects: Some of the common side effects associated with spinal manipulation include radiating discomfort, tiredness, headache, and local discomfort. If patients experience any of these effects, they should report them to their chiropractor or primary care physician.
The Agency for Health Care Policy and Research (AHCPR) has three suggestions for what types of patients are good candidates for these treatments. Their report indicates that good candidates are lower back pain patients who are treated within the first 4 weeks of experiencing symptoms. This patient group has a better prognosis when they are simultaneously participating in low impact physical activities such as swimming, walking and conditioning exercises.