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Can Your Physical Therapist "Adjust" Your Spine?

Joint manipulation (commonly referred to as an "adjustment") can be performed on the joints of the spine, ribs, extremities and more. These high velocity techniques are often associated with the chiropractic profession, however they are not owned by any singular profession and have been part of healthcare practices for thousands of years across the globe. Many are unaware that physiotherapists are often trained to perform joint manipulations which can be a great addition to a holistic plan of care to treat pain and/or movement dysfunction.


The main objective of this article is to provide you with more information about joint and spinal manipulations as we understand them from an evidence-based perspective as well as discuss how they may be incorporated into your treatment at Mend Montana Physiotherapy.


Defining Joint Manipulation

We will define joint manipulation as a high velocity manual therapy technique applied to a joint(s) of the body to achieve a therapeutic effect by a credentialed and trained professional. These techniques can be applied in the middle of a joint's range of motion or at the end-range.


The term "adjustment" is sometimes used to describe these techniques. We will briefly discuss why this term can be misleading in the next section.


How do Joint Manipulations Work?

First, let's be clear that the mechanisms and processes behind joint manipulations (and manual therapy in general) are incredibly complex and are still being studied to improve our understanding.


Many people believe that spinal manipulations or "adjustments" are effective because of the "subluxation theory" which has roots in the chiropractic profession. Unfortunately, the idea of using joint manipulations to move bones into proper alignment and fix "subluxations" is not well supported by the evidence and has resulted in disagreement within and outside of the chiropractic profession. In other words, your skeleton does not behave like a tower of Jenga-blocks that can be knocked and tapped back into proper alignment. If you were to observe the anatomy of a human spine, you would notice that it is heavily supported by ligamentous structures, fascia and stabilizing musculature. It is designed to be incredibly strong and will take much more than the force from a joint manipulation to change its structure!



What does seem to be supported by the evidence is that joint manipulations and manual therapy techniques create a complex "neurophysiological response" that can help reduce pain as well as improve neuromuscular function. The nervous system is affected on multiple levels including the central, peripheral and autonomic nervous systems. There is even research demonstrating changes in hormone levels in the saliva and bloodstream following joint manipulations! To add to the complexity, the beliefs and attitudes of the patient receiving joint manipulation as well as the healthcare provider performing the manipulation can affect the outcomes of the treatment.


The main concept to understand is, the mechanisms behind manual therapy and joint manipulations appear to be more related to your neurophysiology than improving structural-alignment. This explanation is far more challenging for us to wrap our minds around, but it is supported by current evidence.


The "Popping" Sound

Joint cavitation is the term used to describe the sounds heard with some joint manipulations. A common explanation for the sound is based on the change of pressures within the joint which may allow for gas bubbles to collapse. However, recent research suggests this may be an oversimplified explanation and there may be multiple phenomenon occurring at the same time. Just like the mechanisms behind joint manipulation, the verdict is still out!



When Should Joint Manipulations Be Used?

It is important to point out that a single joint manipulation can be very effective when utilized with the right person, at the right time. However, they should be used in combination with other manual and instrument-assisted therapies, movement training and prescribed movement/exercise, pain education, etc.


In general, joint manipulations appear to be more effective for people with more recent symptoms (roughly within a month of symptoms beginning), however they still can have utility with more persistent (chronic) conditions. The research also supports a "multi-modal approach" meaning joint manipulations should be used with other treatment methods (as mentioned above).


Conditions/Diagnoses/Symptoms that May Benefit from Joint or Spinal Manipulation:

  • Headaches & Migraines (Cervicogenic, Tension Type, Mixed Headaches)

  • Neck Pain (Cervical Radiculopathy, Whiplash Associated Disorder, etc.)

  • Shoulder Pain (Subacromial Impingement, Rotator Cuff Dysfunction, etc.)

  • Elbow Pain (Golfer's & Tennis Elbow)

  • Back Pain (Mid & Lower Back Pain)

  • Hip Pain (Hip Impingement, Hip Osteoarthritis, etc.)

  • Knee Pain (Patellofemoral Stress Syndrome, IT-Band Syndrome, etc.)

  • Ankle/Foot Pain (Ankle Sprain, Plantar Fasciitis, etc.)


Wrapping Things Up:


We hope this article has helped give you a more detailed understanding of joint manipulations. Contrary to popular belief, they are not meant to correct the alignment of your body, but to create a neurophysiological change that leads to improved pain and movement. Dr. Ryan MacNeill at Mend Montana Physiotherapy has training in these high velocity techniques and uses them (when appropriate) to help people with a variety of injuries and pain-conditions. If you are curious if joint or spinal manipulation may be helpful for your pain & dysfunction, consider booking a Free Consultation today! Click the button below to get started!


Sources:


Bialosky JE, George SZ, Bishop MD. How Spinal Manipulative Therapy Works: Why Ask Why?. Journal of Orthopaedic & Sports Physical Therapy. 2008;38(6):293-295. doi:10.2519/jospt.2008.0118.

Bialosky JE, Beneciuk JM, Bishop MD, et al. Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. J Orthop Sports Phys Ther. 2018;48(1):8-18. doi:10.2519/jospt.2018.7476


Dunning J, Mourad F, Zingoni A, et al. Cavitation Sounds During Cervicothoracic Spinal Manipulation. Int J Sports Phys Ther. 2017;12(4):642-654.


Funk MF, Frisina-Deyo AJ, Mirtz TA, Perle SM. The prevalence of the term subluxation in chiropractic degree program curricula throughout the world. Chiropractic & Manual Therapies. 2018;26(1). doi:10.1186/s12998-018-0191-1.


Keating JC, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF. Subluxation: dogma or science?. Chiropractic & Osteopathy. 2005;13(1):17. doi:10.1186/1746-1340-13-17.


Macdonald CW, Osmotherly PG, Parkes R, Rivett DA. The current manipulation debate: historical context to address a broken narrative. Journal of Manual & Manipulative Therapy. 2019;27(1):1-4. doi:10.1080/10669817.2019.1558382.


Puentedura EJ, Cleland JA, Landers MR, Mintken PE, Louw A, Fernández-de-Las-Peñas C. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine. J Orthop Sports Phys Ther. 2012;42(7):577-592. doi:10.2519/jospt.2012.4243



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