When does Manipulation Work?

There is some disagreement, even among chiropractors about just what type of back problem manipulation works best for. Dr. Doherty, for example, prefers to deal with acute, rather than, chronic pain. "I can adjust a patient who has had chronic pain for many years, and they usually feel better by the time they leave my office. But by the time they get home, they are right back where they started. In many patients who have had chronic pain for several years, the joints, muscles, and nerves closely connected to these structures have become so modified that anything I do in terms of manipulation is insignificant to the overall scheme of things.

"The people who respond best to manipulation are the people who have made an unguarded movement and as a result have a fixated, or frozen, joint. After the inflammation has subsided, the joint will often remain frozen. What I do is free those joints, and the results are great."

Many chiropractors agree that the longer the patient has had back pain, treated or untreated, the more difficult the problem will be to treat. That is not to say that any patient, regardless of their medical history, will be untreatable, or that the majority of chiropractors won't try. Most chiropractors will take on new clients with a chronic back pain history on a trial basis, with a wait and see approach. But there are no guarantees of spinal manipulation, only the promise that the person performing the manipulation will do everything in their power to help the patient feel better.

People with chronic back pain do have acute exacerbations (episodes where their pain gets worse), and with manipulation chiropractors can at least get their pain and activity levels back to a previous baseline that they had before the flare-up. Manipulation is defined as "an assisted passive motion applied to the spinal facet joints and sacroiliac joints," meaning that the patient is passive while the manipulator assists. Put a little more simply, a manipulator used various techniques to move and loosen up stiff joints so that you feel less pain and a more free range of motion. A mobile joint in general is less painful than a stiff joint. This is true for the facet and sacroiliac joints of your back, as well as your knees, shoulders, and ankles. The more range of motion (ROM) a joint has, the less pressure there is on the joint, and the more comfortable you will feel in that area. Toward the end of a joint's normal physiological range of motion, is a buffer zone. At the end of that, there is an elastic barrier of resistance. This barrier is what back specialists call a "springlike end-feel," which is a result of negative pressure within the joint capsule. (This negative pressure is one of the mechanisms that helps stabilize the joint. Muscles, ligaments and the capsule itself are the others).

If the joint surfaces are forced beyond this elastic barrier by a manipulator, they move apart with a cracking sound, entering what is called the paraphysiological ROM. This constitutes manipulation.