Spinal Manipulation – Safe or Not?
Joint Manipulation or Spinal manipulation is only done by experienced physiotherapist, chiropractor, or osteopath in Singapore. Commonly heard, some of the massage therapists also crack bones and loosen the joints for clients during massage. Occasionally, a few traditional barbers are also manipulating neck after a haircut! Even some people are imitating on such manipulation acts to perform on their own family, friends or own body. Everyone must be aware that there are DANGERS of untrained person, massage therapist or barbers who do not received proper years of professional medical training and clinical practice. Such people who perform such manipulation techniques which it looks like a very simple fast turning move in just a few seconds. However, in a split second, wrong manipulation move may cause serious complications such as tearing of soft tissues, damage of blood capillaries, muscles fibres strain, overstretching of nerves and damaging the joint surfaces. There are even reported incidences of stroke after a neck manipulation! Test and physical assessment must be done before implement manipulation to determine if there is a risk of injury or if a vertebral artery problem is present.
What exactly happens to the joint during a manipulation?
A manipulation is a passive joint movement technique involving a hard sudden thrust to a joint. The joint is usually pushed towards the end of its joint range of movement, and the manipulation gives an extra stretch and movement to mobilise the joint. Often, a loud audible popping sound may be heard as a pressure is released within the joint. This is similar sound of cracking on your knuckles. The aim of using manipulation is to restore normal joint movement – which is a mixture of spin, roll and glide. This treatment technique can help to releases endorphins which are natural pain relievers, unlocks stuck joints, and reduces protective muscle spasm. Manipulation only gives a ‘feeling good effect’ as one heard the popping joint noises and felt joints ‘put back in place’.
Spinal manipulations can relieve neck and back pain by taking pressure off sensitive nerves or tissue, increase range of motion, restoring blood flow, adjustment to spinal alignment.
Careful assessment and analysing of patient’s condition is essential before deciding if manipulation is suitable choice of treatment for the pain problem, otherwise problem may become worsen. Especially for condition spondylolisthesis (displacement of vertebral bone causing spinal instability) or spondylolysis (bone defect or stress fractures, tiny cracks in connection between vertebrae), severe or acute bulging/ herniated disc are often contraindicated and implementation of manipulations techniques may be more harm than good.
Some chiropractor uses only spinal manipulation to adjust spine as their main treatment method. During manipulation, the ligaments are passively overstretched. Repeated manipulation of the spine can cause instability of the supporting ligaments. One should be cautious about signing up for chiro spinal manipulation packages for few months or year as frequent manipulation can cause spinal instability, resulting in joints laxity and pain.
Does physiotherapist do manipulation also?
While physiotherapist’s discretion is to use manipulation as the last treatment resort or only used if patient’s condition is required after careful assessment. Other physiotherapy treatment techniques are used first such as ultrasound, electrotherapy, back traction, neck traction, joint mobilisation (safer technique to mobilise joints compared to manipulation), soft tissue massage, taping, and exercises rehabilitation. There is evidence from a high quality study that spinal manipulative therapy combined with exercise is more effective than other procedures like spinal manipulation, exercise or physician consultation alone.
For a long term or lasting effects to relieving pain, manipulation should not be considered as the only source of pain relief treatment. One should not be dependent on such passive treatment methods. Active treatment techniques such as spinal strengthening exercise, clinical. Pilates taught by physiotherapist is utmost important to build a stronger core spine and postural to prevent pain problem reoccur.