Every once in awhile, I love the sweet relief of feeling my back crack, don’t you? That instantaneous release of pressure and audible sound makes us feel like something good just happened. But, when you’re having low back pain, how do you know if spinal manipulation is right for you? With so many possible causes of your low back pain and so many treatment options, will getting your spine manipulated really make things better? Is it safe?
Let’s take a look at spinal manipulation and how to identify if it’s right for you…
If you’ve ever been to a chiropractor, you may be somewhat familiar with spinal manipulation, as this is a mainstay in many of their treatment approaches for back pain.
Physical Therapists can also perform spinal manipulation, although we only perform these techniques on a particular subset of patients with low back pain – those classified with mobility deficits.
Low Back Pain With Mobility Deficits
If you have low back pain, mobility deficits might present with:
- Low back, buttock, or thigh pain
- Pain on one side only
- Likely an awkward movement brought on your pain
- Reduced lumbar range of motion
- Stiffness in one or more segments of your spine
- Pain reproduced by your therapist pushing on the involved spine segments
- Pelvic girdle or hip mobility limitations
What Is Spinal Manipulation?
Spinal manipulation is a quick thrust mobilization technique of one or more joints. It is used mainly to reduce spinal pain and increase range of motion.
What actually happens when the spine is manipulated?
Well, we know some, but we don’t know all of what happens during spinal manipulation and why it often results in relief.
We do know that the technique results in stretching of joint capsules1.
It’s also hard to ignore the placebo effect this treatment can have…
Is Spinal Manipulation Safe?
Serious complications of spinal manipulation are rare10,11,12, especially when it comes to the lumbar spine. Estimates of the incidence of serious adverse events from published case reports and case series are about 1 adverse event per 1 to 2 million treatments13,14. To put this in perspective, you have a 100-400 times greater risk of serious complications by taking NSAIDs (anti-inflammatories)15.
With that said, here are the contraindications to spinal manipulation16:
- Bone weakening (osteoporosis)
- Cord compression
- Cauda equina compression
- Nerve root compression with increasing neurological deficit
- Aortic aneurysm
- Bleeding into joints
- Lack of diagnosis
- Patient positioning can’t be achieved because of pain or resistance
Who Might Benefit From Spinal Manipulation for Low Back Pain?
Based on validated research, a Clinical Prediction Rule can predict the likelihood of you having a successful outcome from spinal manipulation. If 4 or more of these predictors are present, your probability of success with manipulation increases from 45% to 95%17:
- Duration of symptoms less than 16 days
- No symptoms felt lower than the knee
- Limited mobility in the lumbar spine
- At least one hip has good mobility
- At least 35 degrees of internal rotation
- Low levels of fear
- FABQ-W score less than 19
To simplify things, if these 2 predictors are present, your probability of success with manipulation has a moderate to large shift18:
- Duration of symptoms less than 16 days
- Not having symptoms distal to the knee
Now, this isn’t to say that you can’t benefit from manipulation if you don’t meet these criteria…
However, it is good to keep in mind that spinal manipulation has been found to be no better than other therapies for patients with chronic or longstanding low back pain22.
My best advice: if you and your Physical Therapist decide that spinal manipulation is right for you, it would be best to include it as part of a comprehensive treatment plan25 with emphasis on improving strength and mobility deficits and encouragement to pursue an active lifestyle.”
Exercises For Improving Lumbar Mobility
Spinal manipulation may be beneficial for reducing pain and disability, but if you continue to lack mobility in your lumbar and thoracic spine, there are other mobilization exercises you can perform. Here are a couple simple ones I’d recommend:
- Lumbar Rotations in Hooklying
2. Quadruped Rock Back
Question: What have you found to be most beneficial for improving Lumbar mobility?
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- Pickar JG, Wheeler JD. Response of muscle proprioceptors to spinal manipulative-like loads in the anesthetized cat. J Manipulative Physiol Ther. 2001;24:2-11. ↩︎
- Indahl A, et al. Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine. 1997;22:2834-2840. ↩︎
- George SZ, et al. Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study. BMC Musculoskeletal Disord. 2006;7-68. ↩︎
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- Wright A. Hypoalgesia post-manipulative therapy: a review of a potential neurophysiological mechanism. Man Ther. 1995;1:11-16. ↩︎
- Flynn TW, Childs JD, Fritz, JM. The audible pop from high-velocity thrust manipulation and outcome in individuals with low back pain. J Manipulative Physiol Ther. 2006;29:40-45. ↩︎
- Assendelft W. Bouter LM, Knipschild PG. Complications of spinal manipulation: a comprehensive review of the literature. J Fam Pract. 1996;42:475-480. ↩︎
- Di Fabio RP. Manipulation of the cervical spine: risks and benefits. Phys Ther. 1999;79:50-65. ↩︎
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- Hosek RS, et al. Cervical manipulation. JAMA. 1981;245:922-925. ↩︎
- Powel FC, Hanigan WC, Olivero WC. A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurgery. 1993;33:73-78. ↩︎
- Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther. 1995;18:530-536. ↩︎
- Gibbons P, Tehan P. Patient positioning and spinal locking for lumbar spine rotation manipulation. Manual Therapy. 2001;6:3:130-138. ↩︎
- Flynn T, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002;27:2835-2843. ↩︎
- Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37:290-302. ↩︎
- Childs JD, et al. A clinical prediction rule to identify patients with low bac pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004;141:920-928. ↩︎
- Cleland JA, et al. Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: a randomized clinical trial. Spine. 2009;34:2720-2729. ↩︎
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- Rubinstein SM, et al. Spinal manipulative therapy for chronic low back pain (Review). The Cochrane Library 2011, Issue 2. ↩︎
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- Assendelft WJ, et al. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med. 2003;138:871-881. ↩︎
- Delitto A, et al. Clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012;42(4):A1-A57. ↩︎