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Myths of Manual Therapy Part 2: Spinal Manipulation

Can you be specific with spinal manipulation? It is possible or even necessary?
Erson Religioso

Check out the video - Must be fellowship trained!

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Some research....

Spinal Manipulation effects are multifactorial

  • study looked at candidates who met Clinical Prediction Rule
  • spinal stiffness and multifidus recruitment were measured
  • both appeared to play a role in predicting successful outcomes
  • the technique IS NOT specific (nor does it need to be)

More research

Manipulation Does NOT Alter Sacroiliac Joint Position
  • too many manual therapy clinicians use outdated explanations based on a hip or part of your spine being rotated or out of place
  • clicking on the above link takes you to a study showing that manipulation (and most likely other techniques) does not alter the boney position of the sacroiliac joint
  • the tests that measure position and mobility of this area are not very good anyway
  • even if the treatment did what it was supposed to: "put something back into place" - the tests that measure mobility/position are not valid, a clinician cannot claim they repositioned your joint/bone!
Good news! Pain and mobility is not based on something being out of place, and often cannot be predicted based on what your CT, X-Ray or MRI says! This study looked at over 1000 pain free individuals (100 in each sex and each decade) - even 87% of males and females in their 20s had disc herniations, but had no pain!
Manipulation works for acute pain and in some cases, more persistent pain. That is not in doubt. The myths are perpetuated by well meaning clinicians who are unfortunately out of date. This makes it seem like you need a special technique or "magic hands" to put something back into place or get it to move
However, education, repeated motions, or non thrust manipulation also work, and in many cases better, when paired with self treatment and the right mindset. The bottom line is that very few individuals need to be adjusted or treated regularly to maintain health
The bottom line is that very few individuals need regular treatment to maintain health. Especially when the length of effects after a spinal manipulation last just a few hours. Treatments that improve mobility and decrease pain can be taught with the right education and often easy repeated motions. If they are not reinforced by the patient, they do not last.

Must reads!

Please check out The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model and The Modernisation of Manual Therapy for updated views on Modern Manual Therapy.

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