Spinal manipulation

Spinal manipulation is an intervention performed on spinal articulations, and 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. 

A Cochrane review found that spinal manipulation was no more effective than other commonly used therapies.

There is not sufficient data to establish the safety of spinal manipulations.

A systematic review found SM achieves equal or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up.

A 2019 systematic review concluded that SM produced comparable results to recommended treatments for chronic low back pain, while SM appeared to give improved results over non-recommended therapies for short term functional improvement.

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.

Literature synthesis found good evidence supporting SM and mobilization for low back pain.

Yet av2017 review concluded  nonchronic, nonradicular LBP, available evidence does not support the use of spinal manipulation or exercise therapy in addition to standard medical therapy.

For neck pain, manipulation produces similar changes, and manual therapy and exercise are more effective than other strategies.

Yet a 2015 Cochrane systematic review found that there is no high quality evidence assessing the effectiveness of spinal manipulation for treating neck pain.

A 2007 systematic review reported that there is moderate- to high-quality evidence that chronic neck pain, not due to whiplash and without arm pain and headaches, show clinically important improvements from spinal manipulation or mobilization.

There is not enough evidence to suggest that spinal manipulation is an effective long-term treatment for whiplash.

 44 of 50 studies found no effect of SMT for the management of non-musculoskeletal disorders.

Manipulation under anesthesia

lacks support for its use for chronic spine pain.

There is insufficient data to establish the safety of spinal manipulations.

Spinal manipulation is frequently associated with mild to moderate temporary adverse effects.

Rarely, a  serious outcome can result in permanent disability or death.

Controversy exists regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death: Several deaths have been associated with this technique.

Some find  that there is little evidence for efficacy and some evidence for adverse effects, and due to that, the procedure should be approached with caution, particularly forceful manipulation of the upper spine with rotation.

The correlation between neck manipulation and cervical artery dissection is very weak, but the  literature does not demonstrate that the benefits of cervical spine manipulation outweigh the risks.

Spinal manipulation is most commonly performed by physical therapists, osteopathic physicians, occupational therapists, and chiropractors. 

In Europe, physiotherapists, osteopaths and chiropractors are the majority providers, although the precise figure varies between countries. 

Chiropractors often refer to manipulation of a spinal joint as an adjustment.

The proposed effects of spinal manipulation include:

Temporary relief of musculoskeletal pain.

Shortened time to recover from acute back pain

Temporary increase in passive range of motion (ROM)

Physiological effects on the central nervous system, specifically the sympathetic nervous system.

Altered sensorimotor integration.

No alteration of the position of the sacroiliac joint.

Common side effects of spinal manipulation are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort.

Spinal manipulation has been reported to have beneficial effects on pain, straight leg raise, range of motion, size of discrimination, and neurological symptoms in lumber radiculopathy.

An Iranian study found spinal manipulation was effective in pain control and disability reduction in patients with sub acute or chronic lumber radiculopathy (Hosseini S).

The study found spinal manipulation improve the outcome of the straight leg raise test. 

One reply on “Spinal manipulation”

I like that you mentioned how chiropractic spinal manipulation have beneficial effects on pain, straight leg raise, range of motion, size of discrimination, and neurological symptoms in lumber radiculopathy. My aunt has been complaining about her chronic back pain for quite a while now and we suspect that it is due to her spine. We think she should consult with a chiropractor to have her spine treated.

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