By Chance Moore, DC and Nicole Kibler, DC
Spinal Manipulation techniques have been used to treat back pain worldwide since early recorded history. Artwork and artifacts from different cultures — including Egypt, Native America, Thailand, China, and Japan — depict various forms of spinal manipulation. Hippocrates describes different forms of spinal manipulation using tables similar to modern chiropractic tables. Spinal manipulation was modernized by the founders of chiropractic and osteopathy. Today, spinal manipulation is most closely associated with Doctors of Chiropractic, (DC). There are Doctors of Osteopathy, (DO) who practice spinal manipulation as well.
The spine is made of many small bones called vertebrae. Each vertebra is aligned in a column and connected by small joints. These small joints of the spine can become stuck or restricted, resulting in pain and stiffness. This can be caused by a single traumatic event, such as improper lifting of a heavy object, or through repetitive stresses — like sitting in an awkward position with poor spinal posture for an extended period of time. In either case, injured tissues undergo physical and chemical changes that can cause inflammation, pain, and diminished function.
The purpose of spinal manipulation is to restore joint mobility by applying a controlled force to joints that have become restricted in their movement as a result of tissue injury. In many cases, such as lower back or neck pain, spinal manipulation therapy may be the primary method of treatment. When other medical conditions exist, spinal manipulation may compliment or support medial treatment by relieving the musculoskeletal aspects associated with the condition.
There are many different types of spinal manipulation with more than 100 named techniques. Some forms are gentle and subtle, while others utilize more speed and force. It is important to realize the determination of technique of manipulation is medical decision made between the patient and the doctor performing the manipulation. While some forms of manipulation are not appropriate for patients at risk for fracture or stroke, there are many manipulation techniques that are.
Manipulation is widely recognized as one of the safest non-invasive therapies available for the treatment of neuromusculoskeletal complaints. Still patients fear the associated cracking or popping sound because they do not know what it is. The pop sound occurs when a joint has been moved past the elastic barrier of restriction, but still within the normal range of motion. When this happens, a release of nitrous oxide gas causes the popping sound. This sound is normal and does not indicate damage or injury. There are a wide variety of low force techniques that do not reproduce any noises, the most utilized forms of low force manipulation are flexion distraction and activator.
The flexion-distraction technique is a gentle spinal manipulation procedure performed on a special table that helps to separate the thoracic, cervical and lumbar spinal joints. Light pressure is applied to the spine with the intent to decompress the inflamed areas around the spine to restore normal joint movement. The flexion-distraction manipulation technique is based on a distractive force, supplied with the chiropractor’s hand, combined with table motion. The table is designed to restore normal physiological range of motion to the cervical, thoracic and lumbar spinal joints. Additional goals of the flexion-distraction adjustment include increased nutrients into the spinal disc, decreasing intradiscal pressures and decompressing inflamed/compressed spinal nerve roots.
Activator is a hand-held tool that is designed to give patients a gentle adjustment. The activator tool provides a controlled, fast thrust that is comfortable for the patient. Activator technique is a gentle, low-force approach to chiropractic care. The technique has been used safely on patients of all ages since the 1960s. The technique is especially helpful for children who sometimes have trouble staying still, and is safe for older patients with osteoporosis at risk for fracture. The technique utilizes specific protocols to detect spinal joint dysfunction based on functional leg length inequality. The activator technique is the most widely used low-force chiropractic technique in the world.
Spinal manipulation can be a good compliment to other pain management treatments including epidural injections, medial branch blocks, and medication management. It can also be effective in combination with physical therapy to strengthen and stabilize your spine. A multi-disciplinary approach to treating pain is best. Patients should be encouraged to continue all of your other types of treatments while receiving spinal manipulation therapy. These may include: injections, physical therapy, acupuncture, behavioral assessments and medications. A combined approach of multiple modalities is the most effective way to treat these complicated chronic pain problems.
Other spinal manipulation techniques include:
- Activator Methods
- Applied Kinesiology
- Atlas Orthogonality
- Atlas Specific
- BioEnergetic Synchronization
- Technique (B.E.S.T.)
- Chiropractic Biophysics (CBP)
- Clinical Kinesiology
- Craniopathy/Cranial Therapy
- Directional Non-Force Technique
- Gonstead Technique
- Hole-In-One (H.I.O.)
- Life Upper Cervical Adjusting Technique
- Logan Basic Technique
- Motion Palpation
- Palmer Full Spine Diversified
- Parker System
- Pettibon Technique
- Sacro-Occipital Technique (SOT)
- Thompson Technique (drop-piece table)
- Toftness Technique