What is spinal manipulation?
Manipulation of the spine has been used to treat lower back
pain for many centuries. It goes back at least as far as the ancient
Greeks and Egyptians and perhaps farther.
If spinal manipulation is going to help your back then I don't think it matters much who does it - provided they are properly trained. The techniques of manipulation may be slightly different between different therapists but are not dramatically so. There are only so many ways a vertebra can move and I don't think it matters if the movement is produced by a chiropractor, an osteopath, a physiotherapist, doctor or whoever. The end result is likely to be much the same. For that reason it is seldom worth pursuing a variety of different manipulation treatments if one type has not worked. Try to avoid getting stuck in an endless round of visits to different types of manipulative therapist in an attempt to find the elusive magic cure. You are likely to end up a lot poorer financially and not much better medically.
Spinal Manipulation or Spinal Mobilisation?
There is sometimes confusion about the difference between manipulation of the spine and mobilisation of the spine. They are really just two different grades of the same kind of movement. I can show you what I mean by this if you grasp your own wrist as you read this. Begin by moving it gently backwards and forwards but don't push it as far as it will go. That's mobilisation - movement of a joint without using its own muscles and keeping short of the natural limit of the movement. Now push the wrist as far as it will go until you don't think it can go any farther. If you now give it a gentle but forceful push beyond that limit then you have just manipulated your wrist. In other words manipulation is a small movement beyond natures normal limit for a joint. We have looked at the wrist but the principle is the same for any joint in the body including the spine.
As someone who often treats people by spinal manipulation I feel very strongly that it is important to strip away all the mysticism and mumbo jumbo that surrounds it. Manipulation treatment does have a basis in science. It will only become more widely available if it is seen to be properly researched and based on what we know about the way the body works. Doctors sometimes like to claim a monopoly on medical knowledge but many chiropractors and osteopaths know as much about the spine as some doctors and in some cases are more knowledgeable.
What does spinal manipulation do to the spine?
No one really knows what happens during manipulation but there are many theories put forward. It's easier to tell you what it does not do. It doesn't "put discs back" or put "bones back into place". Putting a slipped disc back in would be like putting toothpaste back into the tube and no X-ray has ever convincingly shown bones moving around under the influence of manipulation. I'm certainly not saying that spinal manipulation doesn't work - simply that science hasn't yet figured out how it does what it does.
We do have some clues however. You may recall in the section of this website about the facet joints of the spine I told you about the little flaps of tissue - called meniscoids - which poke into the space in the facet joints. One explanations for the success of spinal manipulation is that it releases any little folds which might have become trapped in the facet joint space.
You may also have read on the site how the middle of a disc can fill up with toxic fluid that, if it gets into contact with nerves can irritate them. It may be possible to move that fluid around within the disc during spinal manipulation and so make a change in the sufferers symptoms.
These are both just theories but they do seem to make sense based on what we know about discs and joints.
Myths about manipulation
Treatment with spinal manipulation is nowadays so common that I am sure you either know of someone who has had it or have been treated in this way yourself. Despite this there are still a lot of mistaken beliefs about it.
• Myth number one: something should go pop or crack .
Sometimes you or your therapist will hear a cracking noise during
spinal manipulation and say that a disc has been put back or a bone put
back into place. This is rubbish!! The noise happens in the same way
that you can make your finger joints crack by pulling or squeezing them.
It's due to a small bubble of gas in the joint and nothing to do with
the discs or the way the bones line up.
If a noise is heard it often means the treatment is going to work well
but the opposite is not true. Plenty of people have heard lots of
cracking and popping noises but had no benefit from the manipulation
treatment. Even if no noise is heard the spinal manipulation may still
work very well. Try not to feel too disappointed or cheated if your
therapist does not make your back go crack - it really isn't important.
• Myth number two: spinal manipulation should be painful .
It shouldn't be - not under any circumstances. You may experience brief discomfort but if the manipulation treatment is hurting you either at the time or afterwards then it's either the wrong treatment, or it's being given at the wrong time or in the wrong way. Don't let anyone tell you otherwise. Many people have a picture of spinal manipulation treatment as briefly and incredibly painful with a deafening pistol shot crack being heard. They then leap off the couch instantly cured, throwing money and gratitude at the therapist. This is a very false image although it would be nice if it was true.
• Myth number three: it will take several spinal manipulation treatments before you know if it is working .
This again is false. If manipulation is going to be the right
treatment for you then you'll know it very quickly. YOU will
know. You shouldn't need to rely on the therapist producing some funny
test result or describing subtle changes in the movement or shape of the
spine. It should be obvious to you that there is some change for the
better after every session of treatment. You might not be cured or a
hundred percent improved but you should notice an improvement either
straight away or within a day or so at most.
Keep in your mind that most cases of lower back pain will get better
on their own after a few weeks - even with no treatment, and sometimes
in spite of the treatment given. Even though I use a whole range of
treatments to help people with back pain I remain suspicious that some
of these people would get better anyway and that their recovery has
precious little to do with me. You should try to have the same degree of
skepticism and never be afraid to ask questions about your treatment,
no matter how famous or exalted the therapist seems.
As a rule of thumb if three treatment sessions have not produced a noticeable benefit then probably spinal manipulation is not going to be the answer for you.
Lower back pain
What
causes back pain
How
the spine nerves work
Facet
Joint Pain - Sacroiliac Joint Pain
Back
pain, disc pain and disc degeneration
lower back pain and the lumbar facet joints
What
is Lower Back Pain
Why
is my back sore?
Lower
Back Pain Treatment and Referred Pain
First
aid treatment measures for a low back pain attack
Manipulation
Treatment for Back Pain
Acupuncture treatment for lower back pain