On the Mend
The art of spinal manipulation has been around for thousands of years, dating back to medicine men called "bone setters" at the time Socrates lived. Spinal manipulation, also known as spinal adjusting, is one of the most popular forms of treatment for many forms of back and neck pain.
Many clinicians such as physical therapists, chiropractors and physicians use spinal manipulation as a first line treatment option for spine pain. But despite its commonplace in modern medicine, there is still a shroud of mystery surrounding the logic and physical effects of a spinal adjustment.
Here are some of the most frequently asked questions and answers that should help to dispel fears about spinal manipulation for both patients and clinicians alike.
Does spinal manipulation hurt? Nearly all spinal adjustments are performed in a pain free manner. Occasionally, there will be slight to moderate discomfort for a few seconds depending on technique selection or the pathology of the patient. Most manipulations are described as pleasant and therapeutic with no discomfort at any point during the technique.
Do I have to worry about breaking a bone or getting injured? All manipulative practitioners are trained to identify precautions and contraindications to manipulative therapy and should require you to fill out a complete health history form prior to engaging in a treatment. Patients with severe bone loss (osteoporosis) are not candidates for manipulation, nor are patients with strong neurologic involvement. As a general rule, it's a smart idea to discuss your health history with your clinician prior to starting therapy.
What does an adjustment do to my spine? A manipulation carries many positive benefits to patients with spine pain. Foremost, manipulative therapy has been shown to reduce pain better than any other non-medication therapy. Manipulation also acts to distend the vertebrae which alleviates compression from the sensitive discs and nerves. Additionally, joint manipulation fosters better movement and range of motion within the spinal unit. This improvement translates into better function and less pain or the patient.
I have been to both a chiropractor and physical therapist and their adjustments are different. Does this matter? No it doesn't, as long as you feel that you have benefited from it and there is little resultant treatment soreness. All practitioners should be able to deliver a manipulation in a pain-free and effective way — it's part of our training. If you have had good luck with a particular practitioner in the past, I would suggest that you stick with him or her for future episodes of spine pain.
Is there a limit to how many adjustments I can receive? As long as there is a clinical need for manipulative therapy, you can receive as many as you need. It is a temporary modality that helps to alleviate pain in a non-invasive way. Statistically, you are 150,000 times more likely to experience a problem using over-the-ounter medications than you are with an adjustment. It has been reported that upward of 1 percent of all patients undergoing lumbar surgery will have some residual deficits — but the changes of injury from a manipulation are estimated to be one in 3,700,000 manipulations.
Will I need maintenance adjustments every now and then once my spine pain is gone? It is quite possible that you will need a "tune-up" every now and again, but it has been my experience as a practitioner that a home exercise program and extensive education is enough to keep you healthy for a very long time.
If you are wondering if manipulative therapy is right for you, contact a trusted health care provider to weigh out whether manipulation is right for you.
Joe DiVincenzo is a regular Times columnist and a physical therapist and clinical specialist in manual therapy. He writes "On the Mend" weekly for the Living section in Friday's Times. Questions may be submitted to him by e-mail: email@example.com.