Spinal Manipulation

Published on 22/05/2015 by admin

Filed under Physical Medicine and Rehabilitation

Last modified 22/05/2015

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Chapter 26 Spinal Manipulation

OVERVIEW.

Spinal manipulation (also called thrust, chiropractic adjustment) involves passive mechanical movement directed at a specific spinal joint or joint segment in order to restore movement or reduce pain. It is a high-velocity, low-amplitude maneuver performed at the end of the patient’s spinal range, which the patient cannot stop or control. Theories for the pain relief following spinal adjustments include (1) mechanical/reflexive relaxation of soft tissue, (2) movement of a disc bulge away from pain-sensitive structure, or (3) proprioceptive input to the spinal cord to gate out pain.¹

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Six sources cited a total of 47 concerns for spinal manipulation. Concerns ranged from eight to 31 per source, with a physical therapist citing the largest number. The largest proportion of concerns (about 40%) relate to musculoskeletal diseases. The most frequently cited concerns were vertebral artery disease and inflammatory joint disease (all six sources). Other frequently cited concerns included cauda equina syndrome, osteoporosis, metastatic cancer, and anticoagulation disorders. Two sources cited numerous ACIs.

Note: Although authorities suggest adverse events following manipulation are rare, numerous case reports of individuals sustaining vascular damage with subsequent neurologic impairment (particularly following cervical manipulation) have been published over the years in the medical literature.

The list of adverse events for spinal manipulation below is not exhaustive, nor should it suggest an incidence rate. Readers are also reminded that case reports are a weak form of evidence.

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