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To Manipulate Or Not To Manipulate?

What is manipulation?

Manipulation is a word used in the physiotherapy community to mean a certain hands-on or manual technique applied to a joint, usually the spine. This manual technique involves a strong thrust which often leads to a “click” or “pop” sound and pain relief usually ensues.

The chiropractors tend to use the word “adjustments” which essentially means the same thing.  However, amongst the public and even the medical community, there is some confusion regarding the term manipulation.  Some people regard manipulation as an umbrella of manual techniques, which include amongst other techniques, soft / deep tissue massage, mobilization, traction, rolfing, and trigger point release.

The concise definition of manipulation is a technique that winds up the structure to it’s end range position and following that with a high velocity thrust so that the particular joint is taken beyond it’s normal range.  The “click” or “pop” occurs as the gases that are trapped in the fluid within the joint, surface as the pressure in the joint capsule drops. This drop in pressure is from the sudden stretch of the capsule with the thrust. It has been found that after a manipulation, muscles spasm around the structure relax and pain reduces.

Effectiveness of a manipulation

Clinical experience with manipulation of the lower back is extensive and controlled observations show that it is possible to produce immediate relief of pain in some cases.  The effectiveness of manipulation is greatest in patients with acute pain and with no leg pain, numbness or loss of power.  However, the long term effects of manipulation have not been demonstrated.

Contraindications and Precautions

As the technique is relatively aggressive when compared to other manual techniques, it is important to determine the quality of the joint.

Some contraindications would include :

  1. Fractures in the spine, e.g. spondylolythesis, or immediately after a whiplash as the fracture may not show up on x-rays
  2. Conditions that may make the ligaments weak, e.g. rhuematoid arthritis or cancer
  3. Unstable upper cervical spine e.g. when you feel that your head feels unstable when you look up, and after a neck massage you feel dizzy and vomit.
  4. Vertebral artery insufficiency. There is an artery called the vertebral artery that runs along side the neck which because of anatomy, it travels in a more convoluted manner at C2 level, which is in the upper cervical.  When the upper cervical spine is wound up ready for the manipulation, the blood flow in the artery can be compromised if sclerosis is present in the artery, or the thrust can cause a tear in the vessel.  Although the risk is small, it is important to ensure that when a manipulation is done, it is done by a professional. The risk is only significant when the manipulation is done in the upper cervical spine. Those who may be predisposed to this problem often don’t like the neck in extreme position, e.g. hair washing at the saloon with neck tilted backwards.

Precautions to take note of for manipulation would include prolapsed intervertebral disc, and nerve impingement.

Manipulation is generally safe and effective if done properly and when the above considerations are taken.  It is a very useful tool for a locked joint such as a wry neck, i.e. when you wake up with a neck stuck in a position. A manipulation will allow the neck to regain almost full movement.

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