When it comes to who responds best to spinal manipulation, it all depends on the patient’s condition(s). At the time of this article, there are several physical findings that can be found on exams and imaging that show promise that a person will respond to spinal manipulation. Let’s review some…
Spinal Segmental Stiffness
The spine is made up of one bone that sits on top of another bone. These bones have joints that are supposed to be able to move freely when you bend. If there is at least one of these joints that doesn’t move properly, the manipulative procedures may be able to help.
Multifidus Muscle Activation
The multifidus muscle attaches from one spinal bone to another spinal bone. When there is decreased activation and recruitment of this muscle, then the spine is less stable. Spinal manipulation activates this muscle, and it was found that the muscle stays activated over a one-week period in good responders.
Minimal Facet Joint Degeneration
People who have less arthritis in their spines respond better than people who have severe spinal arthritis.
More Localized Symptoms
People with back pain that does not extend past the knee have been shown to be better responders to spinal manipulation. Even people with neck pain that does not extend past the shoulders have been shown to respond better to spinal manipulation.
Shorter Duration of Symptoms
For neck pain, if you have pain for less than 30 days, you should be a good responder, and for back pain, the time frame is 16 days for a better response.
Early Symptomatic Response
If you have a recent neck pain, and you begin to respond in the first week, you have three times greater improvement at 3 months. If your neck pain is old ((>12 weeks), and you respond in the first month, you have six times greater improvement at the 3 month mark.
Back Pain and the Hips
For back pain, if you have at least one hip that can rotate inwards at least 35°, you should respond well.
References:
Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009;14:531–538
Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004;141(12):920–928
Cleland JA, Childs JD, Fritz JM, Whitman JM, Eberhart SL. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: Use of thoracic spine manipulation, exercise, and patient education. Phys Ther 2007;87:9–23
Edgecombe TL, Kawchuk GN, Long CR, Pickar JG. The effect of application site of spinal manipulative therapy (SMT) on spinal stiffness. Spine J. 2013;15(6):1332-8.
Flynn T, Fritz J, Whitman J, Wainner R, Magel J, Rendeiro D, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine 2002;27:2835–2843
Fritz JM, Childs JD, Flynn TW. Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention. BMC Family Practice 2005;6:29.
Fritz JM, Koppenhaver SL, Kawchuk GN, Teyhen DS, Hebert JJ, Childs JD. Preliminary investigation of the mechanisms underlying the effects of manipulation: exploration of a multivariate model including spinal stiffness, multifidus recruitment, and clinical findings. Spine (Phila Pa 1976). 2011;36(21):1772-81.
Fritz JM, Sharpe JA, Lane E, Santillo D, Greene T, Kawchuk G. Optimizing treatment protocols for spinal manipulative therapy: study protocol for a randomized trial. Trials. 2018;19(1):306. Published 2018 Jun 4. doi:10.1186/s13063-018-2692-6
Hebert JJ, Koppenhaver SL, Magel JS, Fritz JM. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: a cross-sectional study. Arch Phys Med Rehabil. 2010;91(1):78–85.
Hildebrandt, Markus & Fankhauser, Gabriela & Meichtry, André & Luomajoki, Hannu. (2017). Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain. BMC Musculoskeletal Disorders. 18. 10.1186/s12891-016-1376-1.
Koppenhaver SL, Fritz JM, Hebert JJ, Kawchuk GN, Childs JD, Parent EC, et al. Association between changes in abdominal and lumbar multifidus muscle thickness and clinical improvement after spinal manipulation. J Orthop Sports Phys Ther. 2011;41(6):389–399.
Pagé I, Descarreaux M. Effects of spinal manipulative therapy biomechanical parameters on clinical and biomechanical outcomes of participants with chronic thoracic pain: a randomized controlled experimental trial. BMC Musculoskelet Disord. 2019;20(1):29. Published 2019 Jan 18. doi:10.1186/s12891-019-2408-4
Park MS, Moon SH, Kim TH, Oh J, Lee SJ, Chang HG, Shin JH. Paraspinal Muscles of Patients with Lumbar Diseases. J Neurol Surg A Cent Eur Neurosurg. 2018 Jul;79(4):323-329. doi: 10.1055/s-0038-1639332. Epub 2018 Apr 16.
Peterson, C.K., Bolton, J.E., & Humphreys, B.K. (2012). Predictors of outcome in neck pain patients undergoing chiropractic care: comparison of acute and chronic patients. Chiropractic & manual therapies.
Tseng YL, Wang WTJ, Chen WY, Hou TJ, Chen TC, Lieu FK. Predictors for the immediate responders to cervical manipulation in patients with neck pain. Man Ther 2006;11:306–315
Wong, A.Y., Parent, E.C., Dhillon, S., Prasad, N., & Kawchuk, G. (2015). Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls? Spine, 40 17, 1329-37
Wong AYL, Parent EC, Dhillon SS, Prasad N, Samartzis D, Kawchuk GN. Differential patient responses to spinal manipulative therapy and their relation to spinal degeneration and post-treatment changes in disc diffusion. Eur Spine J. 2019 Feb;28(2):259-269
Originally published: New Jersey Chiropractor, Spring 2019