MANIPULATION involves twisting the neck or back to the end-of-range, then giving a sudden thrust. This procedure is often accompanied by a pop or click, which is the result of the release of pressure in the joint, similar to cracking one’s knuckles. Sometimes a manipulation may have a lasting effect, but often it is temporary. Manipulation is particularly difficult to perform if the patient has severe muscle spasm or is anxious. Under these circumstances, pain or injury may be worsened by this procedure as the patient is unable to control the movement, or to stop it once it’s started, and spasmed or tight muscles may be torn.
MOBILISATION consists of small passive movements, usually applied as a series of gentle stretches in a smooth, rhythmic fashion to the individual vertebrae. They are applied at various locations on each of the affected vertebrae, and at various angles, directed at relieving restriction in movement at any particular level of the spine. Mobilisation stretches stiff joints to restore range. It also relieves pain by using special techniques. For example, it is especially effective with arthritic joints.
Mobilisations may be administered in various gradations or degrees of pressure. Very gentle “mobes” are used for very sensitive or acute patients to initiate more normal movement. These are called “Grade One” mobes. “Grade Two’s” are administered for pain relief. They are slightly stronger than Grade Ones. “Grade Three” mobes both relieve pain and gently improve the range of motion of stiff joints. “Grade Four’s” are for stretching tight tissues and restoring range in more chronic situations.
Mobilisation is safer because it is done slowly and the patient has the opportunity to stop the procedure if it becomes uncomfortable. It is especially preferable for use with the elderly, as their bones are often more brittle, and osteoporosis does not always show up on x-ray unless quite advanced. It is the procedure of choice when a patient has severe muscle spasm and must be “finessed” into relaxation and stretching. Overall, mobilisation is a safe, gentle, and effective alternative to manipulation.
MASSAGE is the application of touch or force to soft tissues such as muscles, tendons, or ligaments, without causing movement or change of joint position. Massage is different from Mobilisation and Manipulation, both of which focuses on causing movement to the hard-tissues such as the vertebra.