Spinal Manipulative Therapy
The most common therapeutic procedure performed by doctors of chiropractic is known as “spinal manipulation,” also called “chiropractic adjustment.” The purpose of manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile – or restricted in their movement – as a result of a tissue injury. Tissue injury can be caused by a single traumatic event, such as improper lifting of a heavy object, or through repetitive stresses, such as 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 for the sufferer. Manipulation, or adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, and allowing tissues to heal. For more information about the "sublxation", check out a few recent studies.
Chiropractic adjustment rarely causes discomfort. However, patients may sometimes experience mild soreness or aching following treatment (as with some forms of exercise) that usually resolves within 12 to 48 hours.
In many cases, such as lower back pain, chiropractic care may be the primary method of treatment. When other medical conditions exist, chiropractic care may complement or support medical treatment by relieving the musculoskeletal aspects associated with the condition.
Videos
Dr. Terry Schroeder and the U.S. Men's Olympic Water Polo Team
California Chiropractic Association
Click below for a brief video presentation.
Click the picture below to get an updated video presentation of SMT
Click here to follow along with the PowerPoint Presentation
Montel Williams Responds to Chiropractic Treatment
Articles of Interest:
Consumer Reports Magazine Rates Chiropractic Care #1 for Back Pain April 2009
Are Regular Interval Visits Good For You? James E. Greathouse, BS, DC, DACRB
Developing Integrative Primary Healthcare Delivery: Adding A Chiropractor To The Team The Journal of Science and Healing 2008
This project has demonstrated the successful integration of chiropractors into primary healthcare teams.
Making A Case For Chiropractic Care by Dan Murphy DC
Biological Rationale For Possible Benefits Of Spinal Manipulation By Howard Vernon, D.C.
Chiropractic Approach to Lumbar Spinal Stenosis: Part I
Scientific papers regarding this type of therapy:
Do Chiropractic Physician Services for Treatment of Low Back and Neck Pain Improve the Value of Health Benefits Plans? An Evidence-Based Assessment of Incremental Impact on Population Health and Total Health Care Spending.
A Comparison Between Chiropractic Management and Pain Clinic Management for Chronic Low-Back Pain in a National Health Service Outpatient Clinic
The Journal of Alternative and Complementary Medicine Volume 14, Number 5, 2008, pp. 465–473
These results would appear to suggest that chiropractic management can be a cost-effective option for treatment for patients suffering with Chronic Low-Back Pain.
Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment Chiropractic & Osteopathy 2008, 16:5
Resolution of cervical radiculopathy in a woman after chiropractic manipulation
Journal of Chiropractic Medicine (Vol 7, No 1) March 2008
Literature Review - Chronic Mechanical Neck Pain in Adults Treated By Manual Therapy: A Systematic Review of Change Scores in Randomized Clinical Trials Journal of Manipulative and Physiological Therapeutics 2007
Results of Chiropractic Treatment of Lumbopelvic Fixation in 44 Patients Admitted To An Orthopedic Department Journal of Manipulative and Physiological Therapeutics 2007
(Under regular care of the orthopedic surgeons) "...on average, patients with sciatica reported being sick for 72 days." Using chiropractor in the Orthopedic Department) "...The duration of sick leaves among the patients included in this study was 21.1 days. This study shows that a chiropractor may play an important role in an orthopedic department by reducing pain and shortening the duration of sick leaves among patients. And, "Based on these preliminary results, positions for chiropractors should be considered within orthopedic departments."
A Review of the Evidence for the Effectiveness, Safety, and Cost of Acupuncture, Massage Therapy, and Spinal Manipulation for Back Pain Annals of Internal Medicine 2003
“…Spinal manipulation has clinical benefits that are equivalent to those of other commonly used therapies. …these treatments seem to be relatively safe….”
Mechanism of Action For Spinal Manipulative Therapy Joint Bone Spine 2003 Spinal manipulative therapy (SMT) acts on the various components of the vertebral motion segment. SMT distracts the facet joints, with faster separation when a cracking sound is heard. Intradiscal pressure may decrease briefly. Forceful stretching of the paraspinal muscles occurs, which induces relaxation via mechanisms that remain to be fully elucidated. Finally, SMT probably has an inherent analgesic effect independent from effects on the spinal lesion. These changes induced by SMT are beneficial in the treatment of spinal pain but short-lived. To explain a long-term therapeutic effect, one must postulate a reflex mechanism, for instance the disruption of a pain–spasm–pain cycle or improvement of a specific manipulation-sensitive lesion, whose existence has not been established to date.
A perspective for considering the risks and benefits of spinal manipulation in patients with low back pain Manual Therapy 2006
"...Specifically, these data provide preliminary evidence suggesting that a health benefit that does not routinely offer spinal manipulation for patients with LBP may actually increase the likelihood for patients to experience a worsening in disability...."
The Audible Pop From High-Velocity Thrust Manipulation and Outcome in Individuals With Low Back Pain Journal of Manipulative and Physiological Therapeutics 2006
The results of this pragmatic study suggest that a perceived audible pop may not relate to improved
outcomes from high-velocity thrust manipulation for patients with nonradicular low back pain at either an immediate or longer-term follow-up.
The Audible Pop Is Not Necessary for Successful Spinal High-Velocity Thrust Manipulation in Individuals With Low Back Pain Archives of Physical Medicine and Rehabilitation 2003
There is no relationship between an audible pop during SI region manipulation and improvement in ROM, pain, or disability in individuals with nonradicular LBP. Additionally, the occurrence of a pop did not improve the odds of a dramatic improvement with manipulation treatment.
Does an audible release improve the outcome of a chiropractic adjustment? Journal of the Canadian Chiropractic Association 2004
To conclude, an audible release may improve the outcome of a chiropractic adjustment, but therapeutic
benefits of the audible release are likely to be psychological, and not physiological
Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis The Spine Journal 2004
Acute LBP: There is moderate evidence that SMT provides more short-term pain relief than mobilization and detuned diathermy, and limited evidence of faster recovery than a commonly used physical therapy treatment strategy.
Chronic LBP: There is moderate evidence that SMT has an effect similar to an efficacious prescription nonsteroidal anti-inflammatory drug, SMT/MOB is effective in the short term when compared with placebo and general practitioner care, and in the long term compared to physical therapy. There is limited to moderate evidence that SMT is better than physical therapy and home back exercise in both the short and long term. There is limited evidence that SMT is superior to sham SMTin the short term and superior to chemonucleolysis for disc herniation in the short term. However, there is also limited evidence that mobilization is inferior to back exercise after disc herniation surgery.
Mix of acute and chronic LBP: SMT/MOB provides either similar or better pain outcomes in the short and long term when compared with placebo and with other treatments, such as McKenzie therapy, medical care, management by physical therapists, soft tissue treatment and back school.
Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study Clinical Neurophysiology 2007
This study suggests that cervical spine manipulation may alter cortical somatosensory processing and sensorimotor integration. These findings may help to elucidate the mechanisms responsible for the effective relief of pain and restoration of functional ability documented following spinal manipulation treatment.
A Practice-Based Study of Patients With Acute and Chronic Low Back Pain Attending Primary Care and Chiropractic Physicians: Two-week to 48-month Follow Up Journal of Manipulative and Physiological Therapeutics 2004
Study findings were consistent with systematic reviews of the efficacy of spinal manipulation for pain and disability in acute and chronic LBP. Patient choice and interdisciplinary referral should be prime considerations by physicians, policymakers, and third-party payers in identifying health services for patients with LBP.
The Effects of Side-Posture Positioning and Spinal Adjusting on the Lumbar Z Joints: A Randomized Controlled Trial With Sixty-Four Subjects Spine 2002
Spinal adjusting produced increased separation (gapping) of the Z joints. Side-posture positioning also produced gapping, but less than that seen with lumbar side-posture adjusting. This study helps to increase understanding about the mechanism of action for spinal manipulation.
High-Velocity Low-Amplitude Spinal Manipulation For Symptomatic Lumbar Disk Disease: A Systematic Reveiw of the Literature Journal of Manipulative and Physiological Therapeutics 2005
High-velocity, low-amplitude spinal manipulation (HVLASM) for symptomatic lumbar disk disease (SLDD) has been reasonably described in the literature; however, the evidence is limited, and definitive conclusions on safety and effectiveness cannot be made at this time. The reviewed evidence supports the hypothesis that HVLASM may be effective in the treatment of SLDD and does not support the hypothesis that HVLASM is inherently unsafe in SLDD cases. It appears that patients with lumbar disk pathology do undergo manipulative treatment in practice. Consequently, this should be an area of research importance. More high-quality clinical trials using valid and reliable diagnostic criteria and outcomes measures are needed.
Joint cracking and popping: Understanding noises that accompany articular release Journal of the American Osteopathic Association 2002
Articular release is a physiologic event that may or may not be audible. It is seen in patients with healthy joints as well as those with somatic dysfunction. After an articular release, there is a difference in joint spacing—with the release increasing the distance between articular surfaces. Not all noise that emanates from a joint signifies an articular release. A hypothesis about the noise that frequently accompanies this release is offered and includes anatomic, physiologic, and functional models of articular release. Repeated performance of articular release may decrease the occurrence of arthritis. Potential problems from repeated articular release (eg, hypermobility) are also examined.
Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation Spine 2003
The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only non-steroidal anti-inflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies.
A Randomized Controlled Trial Investigating the Efficiency of Musculoskeletal Physiotherapy on Chronic Low Back Disorder Spine 2006
As a component of musculoskeletal physiotherapy, the spinal stabilization program is more effective than manually applied therapy or an education booklet in treating chronic low back disorder over time. Both manual therapy and the spinal stabilization program are significantly effective in pain reduction in comparison to an active control. To our knowledge and up until now, this result has not been shown in patients with chronic low back disorder.
A nonsurgical approach to the management of lumbar spinal stenosis. A prospective observational cohort study BMC Musculoskeletal Disorders 2006
A treatment approach focusing on distraction manipulation and neural mobilization may be useful in bringing about clinically meaningful improvement in disability in patients with lumbar spinal stenosis.
Reflex Effects of Subluxation: The Autonomic Nervous System Journal of Manipulative and Physiological Therapeutics 2000
Recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function.
Spinal Manipulation Effective For Lower Back Pain Journal of Family Practice 2003
Practice Recommendations: Spinal manipulation, usual care, with analgesics, physical therapy, exercises, and "back school" all provide similar results when used for treatment of both acute and chronic low back pain. Clinicians may wish to treat patients with low back pain themselves, or refer them for chiropractic care, physical therapy, or back schools. This decision should be based on patient preferences after reviewing relative risks and benefits. A recent systematic review of the alternative therapies for lower back pain reported similar effects from spinal manipulation and massage therapy. The effectiveness of acupuncture in the management of low back pain remains unclear.
United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care British Medical Journal 2004
Relative to “best care” in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.