Spinal manipulation is performed by a health care practitioner and involves physical pushing, pulling and methodical repositioning of the head, shoulders, neck, back or hips to help alleviate back pain. It can range from massage techniques to slow and steady application of pressure to rapid movement and forceful pressure. Sometimes heat, ultrasound or mild electrical current is used.
Once considered a fringe medical treatment for back pain, more and more medical doctors have adopted the practice of spinal manipulation for low back problems. In their 2007 patient care guidelines, the American College of Physicians and the American Pain Society included spinal manipulation as one of several treatment options for practitioners to consider using when ordinary, uncomplicated back pain (that which is not due to more serious underlying problems such as compression fractures or herniated disc) does not improve with self-care. Evidence indicates that spinal manipulation can provide mild to moderate relief from low back pain and is as effective as conventional treatments when performed by a trained and licensed practitioner.
In addition to medical doctors (M.D.s) who have incorporated spinal manipulation into their practice, there are other practitioners who use it. These include doctors of osteopathic medicine (D.O.s), physical therapists and chiropractors. Many people do not realize that osteopathic doctors must complete the same type of four-year course of study at medical school required to earn an M.D. degree, in addition to fulfilling supplementary educational requirements and hands-on field training afterward. Thus, osteopaths have the same rights, privileges and responsibilities as anyone who has earned an M.D., and are likewise legally empowered to prescribe drugs and perform surgery. As is the case with other medical specialists, physiatrists may be either M.D.s or O.D.s.
A study published in the The New England Journal of Medicine compared treatment outcomes for people with back pain receiving either conventional therapy (such as pain relievers, hot and cold packs and physical therapy) or manipulative treatment. After 12 weeks, the majority of people in both groups felt better, and there was no statistical difference between the groups in terms of quality of improvement. In other words, those who received manipulative treatment fared as well as those who received conventional therapy, except they required significantly less medication. When asked at the final visit, “If you had to spend the rest of your life this way, how would you feel?” 80 percent of the people in both groups said they wouldbe satisfied. Of course, this study had no control group—meaning that people who did nothing might have fared just as well.
So, you might want to consider spinal manipulation as a logical next step if and when pain relievers prove inadequate. It is noninvasive and does not require elaborate technology. The rate of serious complications from spinal manipulation, although not firmly established, appears to be very low overall. The most common side effects are generally minor and include temporary discomfort in the treated area, headache or fatigue. These symptoms usually go away in a day or two.
The Agency for Health Care Policy and Research (AHCPR) recommends treating low back pain with spinal manipulation within the first four weeks of symptoms. They further stress the importance of resuming normal daily activities as quickly as possible.
Manipulation is not for everyone. Spinal manipulation is not advised for people with back pain occurring in association with serious joint or bone disorders such as osteoporosis or disc herniation, as there is a risk that the manipulation procedures will cause more damage, pain and disability. Also, manipulation is not appropriate for people taking anticoagulant (“blood-thinning”) medications such as warfarin (Coumadin) or heparin (Calciparine, Liquaemin).
Opting for spinal manipulation
If you are considering spinal manipulation for low back pain, keep these precautions in mind:
- Certain symptoms, such as sharp pain or low back pain with leg pain or numbness, can be a sign of a serious medical condition that could be made worse by spinal manipulation.
- Spinal manipulation works for some people—but not all.
- Find out ahead of time whether your health insurance will cover treatment by the practitioner you’ve selected. Make sure that he or she is willing to coordinate treatment with your other health professionals, such as your primary care doctor or physical therapist.
- Some practitioners encourage long-term treatment to prevent future problems. But there’s no proof that this does any good.
- Look for a practitioner who provides advice on home treatment and exercises; arrives at a diagnosis through a thorough physical exam and interview, ordering X-rays only in specific cases; and is willing to refer you to a specialist (such as an orthopedist, neurosurgeon or oncologist) when warranted.
- Avoid practitioners who use X-rays as a standard diagnostic test, especially full-body X-rays; use manipulation to treat such ailments as respiratory infections, skin conditions, eye problems and learning disabilities; promote regular manipulation as a way to prevent an unrealistic list of health problems.
- If you discover that spinal manipulation leads to more pain, new pain or numbness in your legs or anywhere else, stop the treatment right away and inform your health care providers.
Published February 01, 2013