Spinal manipulation is a therapeutic intervention performed on spinal articulations which are synovial joints. These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints.

History

Spinal manipulation is a therapeutic intervention that has roots in traditional medicine and has been used by various cultures, apparently for thousands of years. Hippocrates, the “father of medicine” used manipulative techniques, as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of osteopathic and chiropractic medicine. Spinal manipulative therapy gained recognition by mainstream medicine during the 1960s.

Current providers

Spinal manipulation is now most commonly provided by several health care disciplines. In North America, it is most commonly performed by chiropractors, osteopathic physicians, occupational therapists and physical therapists. In Europe, chiropractors, osteopaths and physiotherapists are the majority providers, although the precise figure varies between countries. In 1992, chiropractors were estimated to perform over 90% of all manipulative treatments given for low back pain treatment.

Terminology

Manipulation is known by several other names. The British orthopedic surgeon A. S. Blundell Bankart used the term “manipulation” in his text Manipulative Surgery. Chiropractors often refer to manipulation of a spinal joint as an ‘adjustment’. Following the labeling system developed by Geoffery Maitland, manipulation is synonymous with Grade V mobilization. Because of its distinct biomechanics, the term high velocity low amplitude (HVLA) thrust is often used interchangeably with manipulation.

The effects of spinal manipulation have been shown to include:

  •     Temporary relief of musculoskeletal pain
  •     Shortened time to recover from acute back pain
  •     Temporary increase in passive range of motion
  •     Physiological effects on the central nervous system (specifically the sympathetic nervous system)
  •     Altered sensorimotor integration

Back pain

In 2007 the American College of Physicians and the American Pain Society jointly recommended that clinicians consider spinal manipulation for patients who do not improve with self care options. Reviews published in 2008 and 2006 suggested that SM for low back pain was equally effective as other commonly used interventions. A 2007 literature synthesis found good evidence supporting SM and mobilization for low back pain.

Neck pain

There is moderate- to high-quality evidence that subjects with chronic neck pain, not due to whiplash and without arm pain and headaches, show clinically important improvements from a course of spinal manipulation or mobilization.

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