A chiropractor’s signature technique of treating low back pain is spinal manipulation, with the stereotypical popping noise that’s actually the sound of a gas bubble releasing between joints. Did you know that there are multiple types of spinal manipulation? Some are completed by hand and others require the help of a small, specially designed instrument.

In addition to classic adjustment methods, chiropractors use other special therapies that are designed to reduce pain and improve the health of the spine and surrounding structures.

The specific method your chiropractor will use with you depends on your physical condition and the cause for your underlying back pain. And while chiropractors approach low back pain with a holistic approach, by addressing nutrition, stress, and exercise, spinal manipulation is an important tool for making sure the musculoskeletal system is in optimal alignment and reducing pain.

Here are the most common spinal manipulation and adjustment methods.

Toggle drop

This technique involves the use of a quick, precise thrust to a specific area of the spine to relieve back pain. When applying a toggle drop, the chiropractor crosses his or her hands and then presses firmly down, using the controlled motion to improve mobility in the vertebral joints.

Motion palpation

Rather than an adjustment, motion palpation is a diagnostic tool. It’s a way of observing the spine to identify any areas in the spinal column that are out of alignment or not moving freely.

The practice involves the chiropractor placing his or her hands at specific places along the spine and then guiding the patient through a series of movements. The chiropractor will feel the entire spinal column—from lumbar to thoracic—to identify any areas that feel out of alignment.

Lumbar roll

The lumbar roll is one of the more common chiropractic techniques, particularly for patients with low back pain.

For this technique, patients lie on their sides while the doctor stands on the front plane of the body. The chiropractor applies a rapid, precise thrust to the problematic area, returning the vertebrae to proper alignment.

Release work

Chiropractic release work involves gentle pressure placed along the spine to gently separate the vertebrae and encourage free flow of the spinal column while reducing pain.

Table adjustments

This type of spinal manipulation involves the use of a table that has a drop piece—a portion of the table literally drops below the rest. For this adjustment, the chiropractor examines the patient to ensure the body is in the proper positioning. The chiropractor applies a rapid thrust to the area out of alignment, and the table’s drop piece lowers down at the same time the thrust is applied.

The act of the table dropping down allows the force from the chiropractic adjustment to dissipate, making the adjustment more comfortable for both the patient and the doctor.

While many manual adjustments require the back to be twisted, table adjustments do not require this. This method is highly effective, but also very specialized, requiring both special equipment and skill. Table adjustments are wonderful for unlocking the spine and encouraging total mobility while reducing back pain.

Instrument adjustments

This is a gentle type of spinal manipulation that is not as hands-on as the previously described techniques. Chiropractors use a spring-loaded activator instrument to adjust the spine while the patient lies face down on the table.

The instrument provides a gentle method of freeing vertebrae, and it can also be used on the extremities to encourage optimal alignment.

Humans aren’t the only ones to benefit from instrument adjustments; animals can, too.

Manipulation with anesthesia

Some patients with lower back pain who don’t respond well to traditional spinal manipulations may undergo full anesthesia or twilight sedation before receiving an adjustment. This procedure takes place in an outpatient hospital setting so patients receive full oversight by qualified medical staff.

This type of therapy is typically reserved for those patients whose pain is extremely intense. It’s usually used on patients with chronic low back pain, as opposed to those experiencing pain from an acute cause like an injury or other trauma, according to research published in the journal Chiropractic and Manual Therapies.

Because this treatment is more invasive than other types of chiropractic adjustments, it’s typically not a first-line therapy, and used only when other treatments have failed.

In addition to these methods for adjusting the spine and encouraging proper alignment, chiropractors also use release techniques.

Flexion-distraction technique

People with low-back pain or leg pain resulting from disc injuries may benefit from this commonly used procedure.

To start, the patient lies on a specially designed table that stretches the spine. The chiropractor isolates the area with the affected discs, flexing the spine in a gentle pumping rhythm. Patients should feel no pain.

This procedure is believed to work by moving the disc away from the nerve, which reduces inflammation and pain.

The technique is typically performed over multiple sessions and often in conjunction with other therapies, such as physiotherapy. Patients are usually given exercises to do at home to alleviate the pain related to lower back disc injuries.

If, at the end of 12 sessions, patients have not improved, they’re usually referred for further imaging or a spinal specialist to investigate the problem.

A study published in the Journal of Alternative and Complementary Medicine compared patients with chronic low back pain who received flexion distraction to those who participated in an exercise program. Researchers followed the patients for one year after treatment, and found those who received flexion distraction reported less pain than those who participated in the exercise program.

Pelvic blocking

Another treatment used for patients with disc-related, low back pain is pelvic blocking. This procedure involves the use of cushioned wedges that are placed under each side of the pelvis. The chiropractor begins specific, gentle movements that allow gravity to encourage separation between the disc and the nerve, lessening pain.

This gentle, non-forceful method creates space for healing to happen. In those cases where patients do not demonstrate improvement, they are referred for spinal imaging or a specialist for further review.

Have you experienced any of these treatment methods for low back pain?

Image by Steve Jurvetson via Flickr

Get Free Email Updates!

Weekly updates on conditions, treatments, and news about everything happening inside pain medicine.