The Evidence of Spinal Manipulation and why you should use it.

by | Jul 3, 2020 | Chiropractic Evidence

Written by Jonathan King

 

The Benefits of spinal manipulation and why you should use it.

 

Manipulation, sometimes called Chiropractic Manipulative Therapy (CMT) is something I use every day at King Chiropractic. It’s a primary tool that chiropractors use to treat back, neck and extremity problems. An adjustment improves many bio-mechanical complaints. Stuck joints, painful muscles, disc pain and many common nerve problems. But is this all that manipulation does?

And how do you know that it helps? “He’s a chiropractor right, of course he would say it helps”!

As a Chiropractor, I believe and know it can help. I have seen it work in my own practice and have gained valuable clinical experience. I have read the studies and finished my long stint at university. But is that enough for you?

A number of understandably skeptical people over the years including professions and politicians have expressed remarkable disbelief that manipulation can help. They may have had bad experiences with a chiropractor. They may have heard any number of horror stories from their doctor, physiotherapist or family member. The Chiropractic profession certainly does have its fair share of confidence tricksters and salesman. But so does every institution. Some health practitioners are just ignorant, and dislike chiropractic simply because they have been taught to from their university days. They have been misled by a strong, pervasively negative view of chiropractors. The phrase “they are all quacks, It’s a scam! It will make you worse!” are all variations of the same theme. That there is no evidence for chiropractic care.

So in the interest of evidence based care I thought I would illuminate some of the benefits of chiropractic manipulation using evidence from a few quick google searches. It is by no means an exhaustive list! I have put the reference in an easy to click number hyperlink that underlines and supports the claim. That way if your doctor, physio, mother in law or skeptical family member tells you, “there is no evidence for chiropractic care” you can politely quote a few.

Firstly let’s define Manipulation, or as it is also known within the Chiropractic sphere, “the adjustment”. Manipulation is a skilled therapeutic action which delivers a quick, controlled force over a very small distance. It creates space between the two bones that form a joint. Pulling your finger length ways quickly enough, will separate the joint surfaces between the metacarpal bone of your palm and the lower phalanx bone of your finger. This causes the oil within the joint, which is called synovial fluid, to bubble. The coalescence and subsequent shattering of these bubbles causes an audible “crack”. This process is called cavitation and is exactly the same scientific principle that occurs in water with fast rotating boat propellers and champagne cork popping causing a release of bubbles. Some of the bubbles within the joint hang around for a period of time after the crack, increasing space within the joint and improving range of motion. This gives an amazing feeling of freedom and lightness after an adjustment. If I adjust your neck, you should be able to turn further to the left and the right.

Cavitation also activates many electrical receptors within and around the joint. The activated receptors increase the amount of information sent from the joint to the brain and spinal cord. This can competitively drown out pain signals entering the spinal cord. This is great news for people with severe pain! An adjustment will drown out those painful discomforting signals improving well-being and decreasing pain.

Large amounts of sensory information like the feeling of a joint being moved, interrupt and inhibit overactive muscle signals. Tight and sore muscles are like a computer glitch within our body. If I adjust a joint I can reset the glitch and relax the associated muscles. Quite often I will adjust the base of the neck (T1 -T3) region and get a relaxation of the shoulder muscles. Adjusting the lower thoracic spine can relax the abdominal muscles involved with cramping (good for period pain) and decrease the muscle soreness around the lower ribs. Upper neck adjusting relaxes the muscles involved in headaches decreasing the tight, sore neck feeling that I treat every day.

Adjusting a joint increases sensory information to our brains. Not only does it drown out pain signals, but it also improves our bodies position sense- leading to improvements in balance, reaction time and strength. You should move easier and further, feel less pain, perceive and feel your joints move more accurately and walk with superior balance and co- ordination.

But let’s consider some evidence. I’ll keep it short and sweet!

Neck pain, Headache and Cervical stiffness:

Manipulation is more effective than mobilization in decreasing pain in patients with mechanical neck pain1. Your neck will move further left and right, up and down and side to side. This demonstrates an increased range of motion (ROM) within the neck. Cervicogenic headaches are very well alleviated with cervical manipulation2

Mid back, Thoracic Pain:

Mid back and thoracolumbar range of motion is improved with manipulation3. Pain signals from the thoracic spine are mitigated by the brain and central nervous system after thoracic cavitation4. Diaphragmatic motion and breathing are also improved after an adjustment5. Thoracic spinal adjustments improve breathing and mobility within the mid back.

Low Back Pain and functional manipulation affects:

Low Back Pain with disc herniation and sacroiliac pain has been shown to improve with 5 treatments of spinal manipulation. Functional limitations are reduced for up to a month following treatment6. The short term affect of spinal manipulation produces decreased lumbar pain, increases forward bend (touch toes) and hip flexion during the straight leg test7. Interestingly, patient height (in the short term) increases in males with degenerative disc problems.

Increases in water permeability occur within the Intervertebral disc after spinal manipulation. Improved fluid freedom and moisture diffusion contribute to “washing away” of chemical and inflammatory irritants associated with discogenic pain7,8.

Manipulation also decreases paraspinal muscle activity. Resting Electromyography activity has been shown to decrease after an adjustment to the lumbar spine in the surrounding paraspinal muscles of the lower back. Many patients feel more relaxed, sleep better and suffer less “tight muscle” discomfort. Decreased tension leads to less muscle pain, enhancing movement and wellbeing 9.

Acute and Chronic Low back pain is improved by Spinal manipulation:

Patients suffering acute and chronic low back pain have reported statistically significant, improved outcomes up to 4 weeks after chiropractic care10. In a recent systematic review in 2018 (very high level of evidence). Chronic low back pain was found to improve in both functional limitations as well as pain levels after manipulative treatment. Manipulation was found to be superior to mobilisation11. Simply pushing on a joint is not as good as a firm, focused and precise adjustment.  Acute low back pain treatment was associated with improvements in pain and function up to 6 weeks in a systematic review performed in 201712.

Spinal manipulation was also found to have similar levels of effectiveness as commonly recommended therapies for chronic low back pain (longer than 3 months) such as exercise, anti- inflammatories and simple analgesics13. However, manipulation has the added benefit of improving low back function13.

Spinal manipulation is better than some Anti-inflammatories for Low Back Pain:

Spinal manipulation, consisting of a high-velocity low amplitude thrust to the low back, is better than diclofenac in reducing pain in a select subgroup of people with acute, nonspecific low back pain. Spinal manipulation was found to be clinically superior than placebo meds and diclofenac medication14.

Pain pressure threshold and decreased pain experience:

In 2013 a study of healthy young adults showed a regional decrease in pain sensitivity immediately after spinal manipulation. Adjusting the necks of young adults improved the ability of the patients to withstand painful pressure of trigger points around the neck and shoulder area. This was achieved due to an increase in the pain pressure threshold. Stronger pressures were needed to elicit pain after spinal manipulation1516. This is great news for patients with horrible pain sensitivity. Manipulation decreases pain and suffering improving lifestyle, work and leisure.

Muscle activation and contraction:

In 2019, a study on elbow flexor activation demonstrated increases in strength after a single session of chiropractic manipulation. Electromyography of the elbow muscles showed improvements in force from increased neurological signal activation of the muscle fibres. This was not seen with just passively moving the neck17. The force changes were observed shortly after a manipulative adjustment, indicating manipulation can improve muscle strength from enhanced nerve signals to the muscles.

Reaction Time:

A study on special forces military officers revealed a short- term increase in reaction time following a single session of manipulation. The qualified and asymptomatic, military personnel completed a complex whole-body motor response task that improved after a chiropractic adjustments18. Most of my sporting patients report improved concentration and physical performance after I adjust them. This is why considering chiropractic is a good choice. Concentration and physical performance are essential in every workers life.

Stroke and Spasticity in Cerebral Palsy:

Spinal manipulation can help people with cerebral palsy. I have a small number of patients with brain injuries and post stroke defects, who improve over the short term with Chiropractic Manipulation. Full spine adjusting to the neck, mid back and low back seems to reduce spasticity in Cerebral Palsy patients. Spasticity is the tight muscle rigidity preventing accurate, controlled movements.  Spasticity makes activities like walking, eating and activities of general life quite challenging so improving this gives great relief to suffers. A randomised controlled trial in 2018, found that spasticity decreased after a single session of Manipulation in cerebral palsy patients19. A study performed in 2019 assessed stroke patients with plantar flexor muscle weakness (weakness with toe walking). A single session of chiropractic care was found to result in increased plantar flexor muscle strength and cortical drive to the affected limb20. This is not to say that chiropractic can cure these problems. But Chiropractic care can treat the symptoms, and alleviate the suffering associated with these dreadful conditions.

I think this is a great thing! Give it a go and see if it helps.

Until next time.

Jono.

References:

 

  1. The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial. Cassidy JD1, Lopes AA, Yong-Hing K. J Manipulative Physiol Ther. 1992 Nov-Dec;15(9):570-5

https://www.ncbi.nlm.nih.gov/pubmed/1469341

 

  1. Dose Response for Chiropractic Care of Chronic Cervicogenic Headache and Associated Neck Pain: A Randomized Pilot Study. Mitchell Haas, et al.

https://www.jmptonline.org/article/S0161-4754(04)00239-8/fulltext

 

  1. Immediate effects and associations between interoceptive accuracy and range of motion after a HVLA thrust on the thoracolumbar junction: A randomised controlled trial. Ffion Sian Griffiths, Terence McSweeney, Darren J. Edwards. October 2019 Volume 23, Issue 4, Pages 818–824

https://www.bodyworkmovementtherapies.com/article/S1360-8592(19)30214-1/fulltext

  1. Decreased Neurologic Pain Signature Activation Following Thoracic Spine Manipulation in Healthy Volunteers. K.Weber, T. Wager, J. Elliott, Mackey, W. Liu,  C. Sparks. The Journal of Pain. Volume 20, Issue 4, Supplement, April 2019.

https://www.sciencedirect.com/science/article/abs/pii/S1526590019306716

 

  1. Ultrasound Evaluation of Diaphragmatic Mobility and Contractility After Osteopathic Manipulative Techniques in Healthy Volunteers: A Prospective, Randomized, Double-Blinded Clinical Trial. Damiana Mancini DO. Matteo Cesari MD PhD, Christian Lunghi DO, Augusto Maria Benigni DO PT, Raffaele Antonelli Incalzi MD, Simone Scarlata, MD. JMPT VOLUME 42, ISSUE 1, P47-54, JANUARY 01, 2019

https://www.jmptonline.org/article/S0161-4754(17)30242-7/fulltext

  1. Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study. Shokri, E., Kamali, F., Sinaei, E. et al. Chiropr Man Therap 26, 16 (2018) doi:10.1186/s12998-018-0185-z

https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0185-z

 

  1. Short-term effect of spinal manipulation on pain perception, spinal mobility, and full height recovery in male subjects with degenerative disk disease: a randomized controlled trial. Vieira-Pellenz F1, Oliva-Pascual-Vaca A2, Rodriguez-Blanco C2, Heredia-Rizo AM3, Ricard F4, Almazán-Campos G4. Arch Phys Med Rehabil. 2014 Sep;95(9):1613-9. doi: 10.1016/j.apmr.2014.05.002. Epub 2014 May 24.

https://www.ncbi.nlm.nih.gov/pubmed/24862763

 

  1. Short-term increase in discs’ apparent diffusion is associated with pain and mobility improvements after spinal mobilization for low back pain. Thiry, P., Reumont, F., Brismée, J. et al. Sci Rep 8, 8281 (2018)

https://www.nature.com/articles/s41598-018-26697-7#citeas

  1. Spinal manipulation alters electromyographic activity of paraspinal muscles: a descriptive study. DeVocht JW1, Pickar JG, Wilder DG. J Manipulative Physiol Ther. 2005 Sep;28(7):471. https://www.ncbi.nlm.nih.gov/pubmed/16182019

 

  1. Patient-reported improvements of pain, disability, and health-related quality of life following chiropractic care for back pain – A national observational study in Sweden. Gedina,b, V. Danskb, A.-C. Egmarc,d, T. Sundberge. Journal of bodywork and movement therapies. April 2019 Volume 23, Issue 2, Pages 241–246

https://www.bodyworkmovementtherapies.com/article/S1360-8592(18)30080-9/fulltext

  1. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Coulter ID1, Crawford C2, Hurwitz EL3, Vernon H4, Khorsan R5, Suttorp Booth M2, Herman PM2. Spine J. 2018 May;18(5):866-879.

https://www.ncbi.nlm.nih.gov/pubmed/29371112

 

  1. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis Paige NM, Miake-Lye IM, Booth MS, et al.. 2017;317(14):1451–1460.

https://jamanetwork.com/journals/jama/fullarticle/2616395

  1. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. Sidney M Rubinstein, Annemarie de Zoete, Marienke van Middelkoop, Willem J J Assendelft, Michiel R de Boer, Maurits W van Tulder. 7th February 2019

https://www.bmj.com/content/bmj/364/bmj.l689.full.pdf

 

  1. Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo. von Heymann WJ1, Schloemer P, Timm J, Muehlbauer B.
    Spine (Phila Pa 1976).    2013 Apr 1;38(7):540-8. doi: 10.1097/BRS.0b013e318275d09c.

https://www.ncbi.nlm.nih.gov/pubmed/23026869

 

  1. Immediate effects of spinal manipulative therapy on regional antinociceptive effects in myofascial tissues in healthy young adults. Srbely JZ1, Vernon H, Lee D, Polgar M.
    J Manipulative Physiol Ther.    2013 Jul-Aug;36(6):333-41. doi: 10.1016/j.jmpt.2013.01.005. Epub 2013 Jul 3.

https://www.ncbi.nlm.nih.gov/pubmed/23830709

16.   Changes in Pain Sensitivity following Spinal Manipulation: a Systematic Review and Meta-Analysis. J Electromyogr Kinesiol. 2012 Oct; 22(5): 752–767. Rogelio A Coronado, PT, CSCS, FAAOMPT,Charles W. Gay, DC, Joel E. Bialosky, PT, PhD, FAAOMPT,Giselle D. Carnaby, PhD, MPH, SLP/CCC, Mark D. Bishop, PT, PhD, and  Steven Z. George, PT, PhD

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349049/

  1. Increased Voluntary Activation of the Elbow Flexors Following a Single Session of Spinal Manipulation in a Subclinical Neck Pain Population.

Mat Kingett , Kelly Holt , Imran Khan Niazi, Rasmus Wiberg Nedergaard, Michael Lee and Heidi Haavik. Brain Sci. 2019, 9(6), 136;

 

https://doi.org/10.3390/brainsci9060136

 

  1. Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial. James W. DeVocht,Robert Vining, Dean L. Smith, Cynthia Long,Thomas Jones Christine Goertz. Trials volume 20. Article number: 5 (2019)

https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-3133-2

 

  1. Influence of Spinal Manipulation on Muscle Spasticity and Manual Dexterity in Participants With Cerebral Palsy: Randomized Controlled Trial. OlehKachmar MD, PhD AnnaKushnir MD OlesMatiushenko MD MarkoHasiuk MD. Journal of Chiropractic Medicine

Volume 17, Issue 3, September 2018, Pages 141-150

https://www.sciencedirect.com/science/article/abs/pii/S1556370717301839

 

  1. The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke Kelly Holt, Imran Khan Niazi, Rasmus Wiberg Nedergaard, Jens Duehr, Imran Amjad, Muhammad Shafique, Muhammad Nabeel Anwar, Harrison Ndetan, Kemal S. Turker & Heidi Haavik. Scientific Reportsvolume 9, Article number: 2673 (2019)

 

https://www.nature.com/articles/s41598-019-39577-5