Spinal Mobilisations and Manipulations

Rating

Category: Allied Health Options

What is it?

Mobilisations are gentle, controlled movements of the spinal joints. They differ from manipulation in that they are of slower speed and used with less force. The aim is often to increase the movement of stiff joints and aims to relieve the associated discomfort and pain. They are used by physiotherapists to treat joints that have become stiff from lack of movement, tight muscles, and with stress.

Manipulation is defined as a localised force of high velocity and low amplitude thrust directed at a spinal joint. Manipulation is also known as 'adjustment' or 'cracking'. It involves a qualified professional (i.e. chiropractor, physiotherapist) positioning your body and then applying a small, fast movement, often resulting in a cracking sound. The force may be applied with the therapist's hands or using a piece of equipment.

How does it work?

Spinal mobilisations are thought to work by improving mobility in areas of the spine. Such restriction may be found in joints, connective tissues or muscles. Mobilisation may remove or reduce tension, thereby minimizing discomfort, stress and at times pain. Restoration of spinal mobility, both in physiological movement and in spinal segmental mobility, often results in a reduction in a patient's muscle spasm and allows restoration of the body’s natural energy flow.

It is thought that manipulation of a spinal joint may provide a temporary increase in joint range of movement by acting on the soft tissues around the joint itself. It may also correct spinal alignment and give relief from musculoskeletal tension and/or pain. Manipulation may also have physiological effect on the nervous system and provide pain relief via this means.

Is it effective?

One analysis has found that spinal manipulative therapy was not superior to other standard treatments for lower back pain, while another found that it could be helpful for headaches. A more recent review of the literature found that spinal manipulations and mobilisations did have some evidence of effectiveness in the treatment of both acute and chronic lower back pain and neck pain. However to date there is minimal research in the effectiveness of spinal manipulation or mobilisations as a treatment for PTSD.

Are there any disadvantages?

The literature reports benign, transient side effects (related to either mobilisation or manipulation) such as headache, radicular pain, thoracic pain, increased neck pain, distal paraesthesia, dizziness, and ear symptoms. Mobilisation is generally regarded as being safe but some may experience discomfort during the treatment and over the following day, however this should settle quickly. Some of the disadvantages of manipulation can be more severe but are reported as being infrequent. These include vertebrobasilar accidents (VBA), strokes, spinal disc herniation, vertebral and rib fractures, and cauda equina syndrome. Therefore, appropriate assessment and tests should be carried out by the therapist prior to manipulation.

Where do you get it?

Spinal mobilization and manipulation must be provided only by qualified professionals such as chiropractors, physiotherapists, osteopaths and doctors. There is a list of qualified practitioners on the relevant professional web sites, Australian Physiotherapy Association, Chiropractors Association of Australia, Australian Osteopathic Association and in the yellow pages. While these strategies are pursued, it is also important that the person with PTSD is under the care of a certified health professional.

What are the evidence limitations?

There is currently no explicit evidence to support mobilization and manipulation as an independent intervention for PTSD. Much of the evidence base is derived from lower levels of evidence such as expert opinion and clinical experiences. Therefore interpreting this evidence should be undertaken with caution.

Recommendations

Based on the current lack of high quality evidence, the use of spinal mobilisation and manipulation for the treatment of PTSD cannot be recommended. More research is required. It may be considered as an adjunct to other PTSD interventions, such as psychological and pharmacological interventions.

Key References

Assendelft, WJJ, Morton, SC, Yu, EI, Suttorp, MJ, PG et al. 2003, ‘Spinal Manipulative Therapy for Low Back Pain A Meta-Analysis of Effectiveness Relative to Other Therapies’, Ann Intern Med, Vol.138, pp. 871-881.

Australian Centre for Posttraumatic Mental Health 2007, ‘Australian guidelines for the treatment of adults with Acute Stress Disorder and Posttraumatic Stress Disorder. Practitioner Guide’ National Health and Medical research Council, viewed 11 December 2008,
http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/mh13.pdf

Bronfort, G, Assendelft, WJ, Evans, R, Haas, M & Bouter, L 2001, ‘Efficacy of Spinal Manipulation for Chronic Headache: A Systematic Review’, Journal of Manipulative and Physiological Therapeutics, vol. 24, no. 7, pp. 457-466.

Bronfort, G, Haas, M, Evans, RL & Bouter, LM 2004, ‘Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis’, The Spine Journal, vol. 4, pp. 335–356.

Copyright © Centre of National Research on Disability and Rehabilitation Medicine (CONROD)