Chiropractic AND Osteopathic Manipulation
Manual medicine has been around for a very long time. Often referred to as simply manipulation, references to it have been found dating back to Hippocrates (400 B.C.), Galen (130 – 201 A.D.), and Sir James Paget (1814 – 1899). Forms of manipulation have been prevalent in most cultures recording the history of medicine in their societies. Over all the years the practice of medicine has evolved there have always been physicians who have developed the skillset and cared for patients with manipulation.
In somewhat more modern times, in America, 2 specialists whose practices evolved around manual techniques as a primary focus were Osteopathy and Chiropractic. Both were developed in the late 19th century and popularized in the early part of the 20th century. The methods espoused by these schools of thought and their practical application remained quite controversial until the early 1990s when the scientific literature began to show solid support for manipulation.
The Value of Manipulation
The purpose of manipulation, sometimes called and adjustment, is to restore alignment and normalize mobility in joints that are essentially stuck in a position that does not allow the joint to move through its normal range of motion. Studies with bone pins implanted in both live and cadaveric subjects reveal bone movement of 1 – 2 millimeters and approximately 1 degree of rotation. They additionally reveal an increase in the joint space or gap (that should be there) between the bones that comprise a given joint. This movement results in a number of clinical benefits. It decreases pain, breaks adhesions, and frees trapped meniscoids (cartilage) between joint surfaces. It also has been found to dampen pain input into the nervous system, reduce muscle spasm and increase range of motion. Prone patients with spasm of their back muscles as evidenced by elevated EMG activity, respond to a manipulation by immediate quieting of these muscles. Specialized techniques like Cox decompressive flexion distraction provide additional benefits of increasing the size of the tunnel the nerve root passes through and decreasing pressure inside the discs. In summary there is evidence for both biomechanical and neurological mechanisms by which manipulation decreases pain and spasm, increases range of motion and even increases strength.
Types And Techniques Of Manipulation
Manipulation for some people conjures up image of painful contortions. These are inaccurate. Manipulation performed by experienced doctors, in most cases is painless and entirely comfortable.
There are numerous techniques used by osteopathic and chiropractic physicians. The vast majority in wide utilization today can be classified in one of the following categories: HVLA (High velocity Low amplitude), Cox type decompressive flexion distraction, Non-articulatory techniques, including muscle energy technique and facilitated positional release, myofascial techniques, and instrument assisted techniques. Part of the role of the manipulating physician is to maintain proficiency in a range of techniques and determine in a given patient and condition, which specific technique will be most effective. In our office our specialists utilize gentle techniques that are painless and comfortable.
Adjuncts To Spinal Manipulative Therapy
While spinal manipulation can be utilized as an effective stand-alone therapeutic procedure, it is often used in conjunction with ancillary modalities. These commonly include medications to reduce pain, spasm, and inflammation and additional physical treatments such as electric muscle stimulation, ice, heat, therapeutic ultrasound, support belts, collars and rehabilitative exercise. It also is commonly used in conjunction with trigger point injections and more invasive epidural injections as well as facet and selective nerve root blocks. Finally in patients who have had surgery that is technically successful but who continue to have pain and or disability, manipulation often can be used to correct a functional deficit that was standing in the way of pain relief or improved function.