This highly skilled manipulation involves the chiropractor using their hands to deliver a quick thrust on a specific spinal segment to restore proper movement. Often a popping or cracking noise results, this is safe and harmless. The sound is created by pressure changes in the joint fluid.
Systematic reviews have looked into the safety of chiropractic manipulation. They concluded that, in skilled hands chiropractic is extremely safe, with significantly less side effects than medications or surgery used to treat similar conditions. (1)
Recent extensive systematic reviews (2,3) show manipulation alone is an effective treatment choice for:
- Low back pain, acute and chronic
- Neck Pain, acute and chronic
- Headaches – Migraine & Cervicogenic (from the neck)
- Shoulder blade pain
- Frozen Shoulder
- Tennis Elbow
- Hip and Knee Osteoarthritis
- Patella (knee cap) pain
- Plantar fasciitis
Different Manipulation Techniques
This is a very gentle treatment, so ideal for children, the elderly and small joints such as those in the wrist, ribs and jaw. It is a small handheld device which delivers a quick controlled thrust, similar to manipulation but with no joint popping.
The patient lies on a special table with sections that drop down. We apply a quick thrust at the same time that the section drops a few in order to restore mobility. The dropping of the table allows for a lighter adjustment without the twisting positions and joint popping that can accompany other techniques.
This gentle technique uses wedges called blocks which are slid under the pelvis. They affect pelvic alignment and the lumbar spine mobility (6) by altering the small pelvic rocking motion which occurs during breathing. This effects different nerve fibres from the thrust type manipulation. Patients just have to lie on them, which Ideal for treating pregnant women and people in severe pain who can’t turn easily while lying down.
The cranial or skull bones include the bones containing the sinuses, the inner ear and the jaw bone. These move subtly even when sutures have closed. (7) If we detect restrictions in these bones we may use cranial manipulation to attempt to restore motion.
Effects of Manipulation
The ligaments and muscles are quickly stretched during a manipulation. Every muscle in the body has many small, spring like receptors called muscle spindles, which “tell” the brain where the body is. Each muscle spindle in every muscle will send about 10 signals a second to the spinal cord and influence the tightness and strength of the muscles. They also interact with pain nerve fibres that travel from the surrounding joint and muscles up to the brain; the signals from the muscle spindles block or diminish the pain signals.
Proprioception is the awareness of where the body is, it comes from the muscle spindles and mechanoreceptors (in ligaments). When a joint becomes restricted the signals from the muscles spindles and mechanoreceptors are diminished. The number of muscles spindles and mechanoreceptors also seems to diminish with more wear and tear. Over time the brains awareness of where the joint is will also diminish, reducing the fine control the brain has over the muscles that orientate and protect the joint. This would theoretically:
- Increase the chance of injuring or spraining the joint. particularly when something unexpected happens.
- Increase the wear on the joint because the muscles would respond to changing positions slower, allowing the joint to slop around or grind during movement.
Chiropractic manipulation seems to activate muscle spindle signals to the brain, recent research has found the manipulation to improve joint awareness.
- The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) – University of Ottawa, Canada.
- Effectiveness of manual therapies: the UK evidence report Gert Bronfort, Mitch Haas, Roni Evans, Brent Leininger and Jay Triano Chiropractic & Osteopathy 2010, 18:3 doi:10.1186/1746-1340-18-3
- Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations. Guzman J, Haldeman S, Carroll LJ, et al. Spine 2008;33(4 Suppl):S199-213