Spinal manipulation, the hallmark of Chiropractic Medicine….
First -> Let’s address the elephant in the room! Spinal Manipulation has been touted to help or heal everything from low back pain to the common earache and yearly influenza epidemic. While many practitioners, and patients alike, claim that a chiropractic ‘adjustment’ cured all their ills, current research does not support those claims. We are not here to call those cases out as some people honestly did find an improvement to their conditions through spinal manipulation, we just can not provide consistent results to a large number of subject to clearly understand the mechanism.
However; Low Back Pain, Neck Pain, Muscle and Joint Injuries, Strain/Sprain Injuries…we have mounds of data to support the effectiveness of manipulation and manual therapy in these cases. So much, that we can now predict who will benefit best from this type of care.
What Does Spinal Manipulation Look Like?
Before we jump into what we call ‘Clinical Prediction Rules’ regarding joint manipulation, please realize that each person is an individual, and each condition is as unique as the person who presents with it. Utilizing these rules is not the end all be all; there will be outliers. Some people have tried joint manipulation, or exercise, or dry needling, or a myriad of other therapies with little to no results. Sometimes their condition is passed this type of intervention and needs to bypass conservative care for more invasive options. Moreover, many of these patients either receive ONLY ONE therapy or had the wrong ‘concoction’ of care for their condition, or the phase of healing they were in when the therapy was used was incorrect causing poor timing to be the culprit of poor outcomes. So…if you have tried a few of these, don’t give up and completely write them off. Get a second or third option, look at it with a set of fresh eyes and try a new direction, a new order of care and see how your condition improves.
Now, back to the predictions. Below are what we consider to be the characteristics of patients who research predicts will have the best and fastest outcomes from spinal manipulation.
The Number Of Days With Your Current Low Back Complaint is LESS THAN 16 Days.
Pain & Radiation Of Symptoms (Pain, Numbness, Tingling) Does Not Go Farther Than The Knee.
Fear Avoidance Behavior Assessment. You Do Not Fear That Your Back Pain Will Last Forever and Will Not Keep You From Enjoying Life In The Future.
Through Examination, Movement Assessment, and Provider Palpation, At Least 1 Spinal Segment of the Lumbar Spine is Restricted/Hypomobile.
At Lease 1 Hip Has More Than 35 Degrees of Internal Rotation.
So What Does This Mean?
If you present to an office like ours with ACUTE LOW BACK PAIN that is RADIATING PAIN TO THE GLUTES, RESTRICTED LUMBAR SPINE ROM, and ONE HIP HAS RESTRICTED INTERNAL ROTATION ROM…
YOU ARE A GOOD CANDIDATE FOR SPINAL MANIPULATION
&
WE SHOULD ANTICIPATE GREAT RESULTS.
Two studies on spinal manipulation, utilizing these Clinical Prediction Rules found:
Patients who presented with less than 4 of the 5 above rules, had a 45% likelihood for a positive response from spinal manipulation.
Positive Response means that after 2-3 treatments with spinal manipulation, patients saw a 50% reduction in symptoms and pain.
A patient who presented WITH at least 4 of the 5 rules, increased their likelihood of a positive outcome to 95%.
Another study, utilizing a side-lying lumbar manipulation technique along with ROM exercises, found a 50% reduction in symptoms in 11 of 12 participants. The one participant who did not respond still found a reduction in symptoms, but did not reach the 50% reduction mark the study considered as a ‘positive outcome.’
In summary, Spinal Manipulation is an effective and safe tool for low back pain. But it is just that, a tool! Care that relies on only one treatment modality will only be somewhat useful to a specific, and small, population. Care that focuses on the patients' individual presentation and goals, and adapts a variety of therapies for that particular condition will typically yield the best results. If you have tried manipulation, PT, massage, dry needling, or any other therapy as a stand-alone treatment option, I invite you to give us a call to see how we can develop a better treatment plan around your personal goals.
Resources:
Cleland, JA et al. The Use of a Lumbar Spine Manipulation Technique by Physical Therapists in Patients Who Satisfy a Clinical Prediction Rule: A Case Series. JOSPT 2006.
Flynn, T et al. A Clinical Prediction Rule For Classifying Patients With Low Back Pain Who Demonstrate Short-Term Improvement With Spinal Manipulation. Spine 2002.
Childs, JD et al. A Clinical Prediction Rule To Identify Patients With Low Back Pain Most Likely To Benefit From Spinal Manipulation: A Validation Study. Annals of Internal Medicine 2004.
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.