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Spinal Manipulation

Spinal Manipulation (Chiropractic)

Spinal Manipulation Treatment

Introduction

Chiropractic care focuses on the relationship between the body’s structure, mainly the spine and its functioning. Spinal adjustment/manipulation is a core treatment in chiropractic care, and involves application of a controlled force to the joints of the spine. The main goal of this treatment is to bring the spinal joint or joints with restricted movements to the normal range of movement. Professionals, such as chiropractors, osteopathic physicians, naturopathic physicians, physical therapists, and some medical doctors, practice spinal manipulation. This technique is mainly used to relieve pain and improve physical functioning.

History

Chiropractic care especially the spinal manipulation has its origin of development in different parts of the world, where it was practiced to treat a variety of musculoskeletal conditions, including spinal disorders. Greece is believed to provide the first direct evidence of practice of spinal manipulation. Hippocrates, who is often referred to as the “Father of Medicine,” first described spinal manipulative technique.

The Chiropractic Care was developed by Daniel David Palmer, who performed the initial chiropractic adjustment in September 1895 on a janitor who had become deaf. Palmer examined the area in the patients back, and successfully adjusted a misplaced vertebra in the upper back. DD Palmer continued to develop chiropractic practice, and in 1897 established the Palmer School of Cure. Today spinal manipulation technique is practiced widely, and there are more than 60,000 active chiropractic licenses in the United States.

Biological Mechanism of Spinal Manipulation

During spinal manipulation the practitioner applies a controlled rapid force to the spinal joint. The main goal is to improve the mobility of the jointand restore its normal function. The practitioner delivers an impulse to the specific vertebra with controlled magnitude, velocity, and direction. The skill of spinal manipulation is determined through these three factors. Spinal manipulation technique is sometimes characterized by fluid cavitation created due to gapping the joint. The cavitation is often, but not necessarily accompanied by a cracking or popping sound (audible release). Research suggests that such a sound could demonstrate suppression of inflammation causing substances, called as pro-inflammatory cytokines, e.g. tumor necrosis factor α(TNFα) and interleukin 1β (IL-1β).

Therapeutic Benefits

Chiropractic care is mainly indicated for treatment of low back pain or neck pain. It also can relieve other discomforts of the musculoskeletal system, which includes all joints and muscles. Some evidence suggests that chiropractic can be useful in management of menstrual pain, headaches, and sinus disorder. However, there is no sufficient evidence to support this.

Low Back Pain

Clinical evidence suggests that spinal manipulation is an important treatment option for relief from low back pain. Studies suggest that spinal manipulation is as effective as conventional treatments, such as applying heat or taking pain-relieving medications. In 2007, the American College of Physicians and the American Pain Society guidelines included spinal manipulation as a treatment option to be considered when self-care measures fail.

Neck Pain

Neck pain is the second most common reason why people seek chiropractic care. Studies report that spinal manipulation causes reductions in pain and disability due to neck pain.

Headache

Chiropractic can also be used in the treatment of tension type of headache. Some studies also suggest that chiropractic is better than massage in relieving headache. However, there is insufficient evidence to support the positive role of  chiropractic in treatment of headache.

 

Use of Chiropractic Care

  • A study conducted in 2012 suggests that, in year 2008, nearly five percent people used chiropractic care in the US. People from high-income families, whites, women, and those suffering from arthritic condition reported higher prevalence of chiropractic use.
  • Another recent study reported that spinal manipulative therapy presents as a cost-effective treatment to manage neck and back pain, when used alone or in combination with other treatment approaches.
  • Literature search regarding spinal manipulation in regions such as North America, Europe, and Australia reveals that back and neck pain are the most frequent indications for receiving spinal manipulation. The patient satisfaction with spinal manipulation was reported to be very high.

Risks and Side Effects

  • Clinical studies have reported that spinal manipulation used for treatment of low back pain is generally safe. However, some people may feel tired, or have temporary soreness.
  • Side effects from spinal manipulation can also include temporary headaches, or discomfort in the parts of the body that were treated.
  • Some reports indicates that in rare cases spinal manipulation can cause complications such as caudaequina syndrome (CES)characterized by narrowing of the lower part of the spinal canal in which nerves become pinched and may cause pain, weakness, loss of feeling in one or both legs, and bowel or bladder problems.

 

What to Expect During Your Visit to the Chiropractor?

  • At your first visit, the chiropractor may take your entire medical history to understand your symptoms well and perform a physical examination with special emphasis on the spine.
  • During your subsequent treatment sessions, the practitioner may perform one or more of the many different types of adjustments and other manual therapies used in chiropractic care.
  • Chiropractors may combine the use of spinal manipulation with other treatment approaches, such as, electrical stimulation, relaxation techniques, exercise, dietary supplements, etc.

Practitioners’ Certification

Chiropractic colleges accredited by the Council on Chiropractic Education (CCE) offer Doctor of Chiropractic (D.C.) degree programs. Chiropractic training is a 4-year academic program that includes both class work and direct practice with patients. Chiropractors require completion of a Doctor of Chiropractic degree program from a CCE-accredited college, for practice in any state in the US.

References

  1. PettmanE. A History of Manipulative Therapy. The Journal of Manual & Manipulative Therapy 2007; 15(3):165–174.
  2. Spinal Manipulation. Available online: http://nccam.nih.gov/health/spinalmanipulation?nav=gsa. Last assessed December 20, 2013.
  3. Origins and History of Chiropractic Care. Available online: http://www.chiro.org/LINKS/FULL/Chiro_History.pdf. Last assessed December 20, 2013.
  4. Pickar JG. Neurophysiological effects of spinal manipulation.Spine J. 2002;2(5):357-371.
  5. Teodorczyk-Injeyan JA, Injeyan HS. Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment.ChiroprOsteopat. 2008 28; 16:5. 
  6. Bronfort G, Assendelft WJ. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative PhysiolTher. 2001; 24(7):457-466.
  7. Shekelle PG. Benefits And Risks Of Spinal Manipulation. Available online: http://www.chiroweb.com/archives/ahcpr/chapter11.htm. Last assessed December 20, 2013.
  8. Zodet MW, Stevans JM. The 2008 prevalence of chiropractic use in the US adult population. J Manipulative PhysiolTher. 2012; 35(8):580-588.
  9. Michaleff ZA, Lin CW. Spinal manipulation epidemiology: systematic review of cost effectiveness studies. J ElectromyogrKinesiol. 2012; 22(5):655-662.
  10.  Hurwitz EL. Epidemiology: spinal manipulation utilization.JElectromyogrKinesiol. 2012; 22(5):648-654. 

 

 

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