Spinal manipulation is a commonly used technique at Natural Therapies Centre for those with simple back and neck pain. It is used to treat areas of spinal segmental dysfunction where there are symptoms of painful muscle spasm and restricted spinal movements. In trained hands it is a safe, effective and comfortable treatment. It may be also used in those with certain types of Spinal Nerve Root Pain

Specific Terms commonly used to describe the indications for spinal manipulation - Hypomobility, Motion restriction, Joint fixation, Acute joint locking, Motion loss with somatic dysfunction, Somatic Dysfunction, Restore bony alignment, Meniscoid entrapment, Pain modulation, and Reflex relaxation of muscles

Assessment

History

A proper history should be taken which notes the mode of onset (sprain, postural, or spontaneous onset), progress over time, alleviating and aggravating factors, and red flags which may suggest nerve root involvement or other sinister causes.
Past medical history and current medications should be noted to help exclude conditions which would make manipulation inadvisable. A general assessment of mental state is also advisable, noting abnormal pain behaviour, anxiety and depression - often called "yellow flags".

Examination

• Examination should be thorough to help eliminate serious red flag conditions. Neurological examination (reflexes and muscle power) should always be performed to exclude nerve root compression.



• Practitioners often use a system of examination called ARTT to look for signs of somatic dysfunction:-



• A = Asymmetry where there is an obvious difference in the appearance in an area compared to the opposite side.
• R = Range of motion where an area is either moving normally, in a restricted way, or is showing signs of hypermobility.
• T = Tissue texture where there is a difference between two areas when touching the soft tissues (skin, fascia, muscles).
• T = Tissue tenderness where there is a difference in the painful pressure threshold to touch in the muscles in an area.



• The whole of the spine should be examined as well as looking at leg lengths and pelvic alignment. Examination will often involve touching the spinal muscles looking for areas of spasm and pain, along with a functional assessment which includes looking at passive and active spinal movements, noting areas of reduced movement (hypomobility), and noting areas of reduced movement (hypomobility), and increased movement (hypermobility).

Investigations

Should the history and examination suggest red flags, then further investigation is necessary. Simple tests include full blood count, ESR, and X-rays. An MRI scan is also useful in cases of suspected nerve root involvement.

Technique

• Manipulation involves encouraging the "stiff" area of the spine to begin moving again, and comprises soft tissue massage, gentle mobilisation movements (articulation), and firmer carefully controlled movements (high velocity low amplitude thrusts - HVT's) which stretch the stiff part often accompanied by a series of "clicks" or "pops".
• Each "pop" or "click" represents a spinal facet joint being released from its restricted state. This is similar to clicking your knuckles. These maneouvres often result in a very rapid reduction in spinal muscle spasm and pain, accompanied by a noticeable increase in the range of spinal movements. Manipulation combined with regular specific exercises seem to the most successful at maintaining the mobility of a previously stiff area

Managing other illnesses through correcting spinal abnormalities

Other bodily systems such as bone, muscles, ligaments, joint-capsules and your inter-connective muscle tissues become troubled because of spinal abnormalities. Your nervous, endocrine, digestive, circulatory and respiratory systems can also begin to suffer. The following problems have been successfully managed :

o Neck and back paino Headaches and migraines
o Asthma and sinus o Whiplash o Menstrual problems
o Sports injuries o Face pain and TMJ Joint dysfunction
o Gastrointestinal problems o A bad posture