The practice of manipulative thrust therapy can be dangerous and cases of injuries and tragic events have been recorded. Cases of vertebral artery dissection (VAD) have been recorded in people that had the cervical spine manipulation technique done and research on the cases from 1966 to 1993 concluded 30% could be attributed to the procedure (Cleland 2007). VADs are spontaneous and can be normally present at the initial onset of headaches or neck pain. This represents the conclusion that the VAD was present before the technique is performed on a patient complaining of neck pain. The debate over the truth is still being waged. Even authors have joined the debate but they are touted as biased and do not support the evidenced based in research (User’s Guide 2008).
Other debates rage as well. The risks of the manipulative thrusts therapies are actually no worse the risks from NSAIDs and cervical spine surgery. The primary risk involved in lumbopelvic region has been deemed as cauda equine syndrome and the adverse effects fro m the thrust therapy is roughly 1 in 6 million (Cleland 2007). It has been documented that certain people with low back pain respond immediately and dramatically with the manipulation and established patients that do not receive the therapy often have their conditions deteriorate and worsen as time goes on.
Physiology and physical therapy derived from traditional medical treatments is a way for physical interactions including physical therapy to be used in the alleviating of pain and more importantly the cause of the pain. Advanced manipulative therapy involves the use of soft tissue and joint mobilization in the treatment of musculoskeletal, sports and occupation injuries.
The terminology of spinal manipulative therapy (SMT) is most widely known as the manual treatments associated with soft tissue techniques, low velocity high amplitude mobilization, and high velocity low amplitude manipulative thrust (Maigne & Vautravers, 2002). SMT is accomplished by acting on the structure of the vertebral movement segments. The technique operates by the quick separation of the facet joint until a slight crackling sound is heard. The disk pressure has been noticed to decrease and the stretching of the spinal muscles occurs; thus causing relaxation and induces mechanisms of relief that are not yet clearly defined. These techniques give a temporary relief but must be repeated in continuous sessions to gain the full effects of the treatment.
The thrusts works by their application on the patient’s body to simulate the movement as a lever or by a direct process involving the spinal processes (Maigne & Vautravers, 2002). Most of the spinal manipulative thrust motion is directly absorbed by the spinal region while a small portion is absorbed by the spinal soft tissues. Several levels of vertebral column can be affected by the leverage effect of the spinal column depending on manipulation applied and the extent of the manipulation.
Cavitation is described as the formation and collapse of low pressure bubbles in liquids or the formation of cavities in the body. The cracking sound heard during the SMT is a direct result of the cavitation of the spinal joints and studies have been conducted on its effects in the metacarpophalangeal joints. Traction does not relieve the pressure very quickly in these joints; but the cracking of these joints causes the cohesive forces to release allowing the pressure to be relieved. SMT allows the thrust to be exerted at a level that causes the immediate release of the gas and vapor at very high speed.
The results conclude form this study indicates that SMT can reduce the pain of some patients with back pain caused by disk related issues (Maigne & Vautravers, 2002). The cause of some lower back pain may be the result of a nucleus fragment trapped in the radial crack of the annulus (Maigne & Vautravers, 2002). Returning the fragment to its central location by the use of SMT may be achieved by endplate separation, the stretching of the posterior longitudinal ligament, and the relieving of the internal disk pressure (Maigne & Vautravers, 2002). Further testing is desired to fully test and interpret the full scope of this study.
Stretching of the paraspinal muscle, ligaments, disks, joint capsules through the use of SMT can induce pain relieving effects of the body. The release of endorphins after the SMT is completed shows to be increased (Maigne & Vautravers, 2002). The SMT may also increase the blood flow to the region and cause the clearing of toxins from the affected region.
According to Maigne & Vautravers, (2002) in the article, “Mechanism of Action of Spinal Manipulative Therapy,” they conclude saying:
” Improvements in the knowledge of the mechanism of action of SMT suggest that at least three anatomic effects should be sought: on the side of the pain (determined by the physical examination), the facet joint surfaces should be separated, the paraspinal muscles (and psoas muscle at the lumbar level) should be stretched; and the intradiscal pressure should be lowered. Selection of the optimal type of manipulation for a given patient should be based on these goals. Manipulative techniques probably vary in their ability to stretch the paraspinal muscles, decrease intradiscal pressure (by increasing lumbar lordosis), and gap the facet joints, and deeper differences probably exist between chiropractic and osteopathic techniques. Researchers investigating manual techniques should strive to elucidate the biomechanical consequences of each manipulative technique on the vertebral motion segment.”
The effects associated with SMT and the manipulative thrust therapies are definitely beneficial and more studies need to be conducted to further understand all the mechanisms associated with their success.
The doctor performing any of the manipulative treatments should be fully trained and tested to ensure he is capable of performing the techniques. Only competent osteopathy doctors, advanced physiotherapists, and chiropractors should be permitted to engage in these forms of therapies due to the serious injury that can result from a slight miscalculation.
Manipulative thrust therapies provide excellent opportunities to cure the underlying causes of lower back, shoulder, and neck pains without the long drawn out processes employed by the regular medical community. Implementation of these techniques may help cure chronic and severe ailments in patients that now rely heavily on medications to alleviate the pain. One has to wonder if some surgeries could have been avoided through the use of manipulative thrust and similar therapies associated within the field of osteopathy.
Medical doctors should work more closely with the administrators of the thrust therapy to help eliminate the enormous quantities of pain killers being administered daily and causing some people to become addicted to them. The field of alternative medicines should be evaluated more closely to eliminate the false cures and promote the ones that will truly benefit the patient.
Chiropractors and Physiotherapies may also help eliminate the prescribing, dispensing, and dependence that several nations are experiencing with patients. To treat the cause and not just the pain should be the goal of all medical providers.
Anonymous. “Activator turns 35.” Dynamic Chiropractic. Dynamic Chiropractic CA. 2001. HighBeam Research. 24 Apr. 2010 .
Anonymous. “Study Finds “Manual Therapy” Effective for Shoulder Dysfunction/Pain.” Dynamic Chiropractic. Dynamic Chiropractic CA. 2004. HighBeam Research. 24 Apr. 2010 .
Anonymous. “Journal of Manipulative and Physiological Therapeutics.” Dynamic Chiropractic. Dynamic Chiropractic CA. 2006. HighBeam Research. 24 Apr. 2010 .
Australian Journal of Physiotherapy 2001 Vol. 47-163-24 April 2010