Spinal manipulation – physiopedia escoliosis lumbar

By The U.S. Army (www.Army.mil) [Public domain], via Wikimedia CommonsManipulation is a passive technique where the therapist applies a specifically directed manual impulse, or thrust, to a joint, at or near the end of the passive (or physiological) range of motion. This is often accompanied by an audible ‘crack’ [1]. The common feature of spinal manipulation techniques is the fact that they achieve a pop or cracking sound within synovial joints. The cause of this audible release is open to some speculation but it is widely accepted to represent cavitation of a spinal facet joint [2]. When there is a lower pressure than normal in the facet joint, gas bubbles are being formed in the joint.


At the moment that the pressure rises, the bubble implodes, this is called cavitation.

It is a intervention Physiotherpists have been employing since the beginning of physical therapy practice. However, physiotherapists providing spinal manipulations have come under the scrutiny of other professions even though manipulation is not exclusive to any one domain or profession. The challenge has been brought forth to many state legislators because some chiropractors have argued that manipulations are not within the scope of physiotherapy practice. The APTA has created a page that delineates the difference between physical therapy manipulation and chiropractic manipulation [3]. They have also published a manipulation education manual [4].

Spinal manipulations can relieve back pain by taking pressure off sensitive nerves or tissue, increase range of motion, restoring blood flow, reducing muscle tension, and, like more active exercise, promote the release of endorphins within the body to act as natural painkillers.

The underlying pathological cause of low back pain (LBP) is only determined in about 15% of all cases. Because of this, there has been much confusion and debate about the best way to treat patients with LBP. There have been numerous studies done to determine the effectiveness of different treatment interventions for these patients. Evidence has been conflicting regarding the effectiveness of spinal manipulation as an intervention in this patient population. Spinal manipulative therapy is less effective than often assumed. The enthusiasm for this treatment as thé treatment for low back pain should be tempered. There is no evidence found that spinal manipulation is superior to other therapies such as back schools, physical therapy and exercises. But it is also not proven that these therapies are superior to spinal manipulation. So spinal manipulation is one of the several options for the treatment of patients with low back pain. The remark that all these findings are of modest effectiveness should be kept in mind [6]. Next to it, manipulations are found more effective in the acute than in the chronic cases of low back pain. It has to be noticed that manual therapy is only indicated in the acute cases which have a varied course [7]. On the other hand, it is proven that spinal manipulative therapy appears to be no better or worse than other existing therapies for patients with chronic low-back pain [1].

The best way of using the manipulations is in combination with other therapeutic modalities. 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 [8].

Flynn et. al determined that patients that meet certain criteria were more likely to experience short-term improvements with spinal manipulation. A clinical prediction rule was developed in order to identify these patients with LBP who will most likely benefit from spinal manipulation. Spinal manipulation is a sub-group of the Treatment-Based Classification Approach for low back pain.