Back and neck pain are two of the most common reasons why individuals seek care from a health professional. A popular manual treatment technique at the back and neck is a thrust manipulation. Most people at some point in their life have seen a YouTube video of someone causing a loud crunching sound after manipulating someone’s back, but does it help reduce pain and improve function? Current research suggests that spinal manipulation can be an effective technique when addressing back pain. The following is a guide for those who are experiencing spinal pain and dysfunction, but unsure if spinal manipulation is right for them.
A word of caution
It is recommended to only receive spinal manipulation from trained and licensed health care professionals. Many individuals have friends who claim they can “crack” their back, but improper training and technique can lead to further injury. Be cautious of “do it yourself” YouTube videos.
What is spinal manipulation
A spinal manipulation is when a practitioner uses their hands or a device to provide a controlled thrust in a specific direction, magnitude, and speed, at a joint of the spine, to attempt to improve joint mobility and reduce pain and dysfunction.
Physical Therapist role
It is within physical therapist scope of practice to screen, evaluate, and perform spinal thrust manipulate. Within the DPT curriculum, therapists are highly trained to safely perform spinal manipulation, and identify red flags when referral to another professional is needed. Many therapists also seek continuing education after school for advanced manual techniques.
Who benefits from spinal manipulation?
An individual experiencing spine pain or dysfunction should get a comprehensive examination from a qualified health care professional to determine if spinal manipulation is an appropriate treatment. Research has also identified several factors at each segment of the spine that increases the chance of having a successful response, which are listed below.
Low Back thrust:
- Duration of symptoms/pain less than 16 days
- Decreased range of motion at the lower back
- No symptoms past the knee
- At least one hip with good range of motion
Mid back thrust:
- Symptoms/pain less than 30 days
- No symptoms past the shoulder
- Looking up does not worsen symptoms
- Decreased neck range of motion looking up
- Abnormal posture at the mid back
Neck thrust:
- Symptoms less than 38 days
- Decreased range of motion looking right or left
- Feeling better while moving the neck
- Looking up does not worsen symptoms
- Positive expectation that the manipulation will help
- No shooting pain down the arms
Note: the above factors are predictive guidelines only. They do not necessarily exclude treatment.
Multimodal treatment
When treating spine pain and dysfunction, physical therapy is more than just spinal manipulation. Spinal manipulation can help improve motion and reduce pain at the spine but may not address the underlying issue. Physical therapy can help improve movement patterns at the spine, improve spine range of motion, flexibility of muscles, improve core strength, and facilitate better posture. Spinal manipulation is just one of many tools a therapist may utilize when designing a care plan with their clients.
Bottom line
To briefly summarize; spinal manipulation has been shown to be effective in treating patients with back pain or mobility dysfunction. Individuals whose pain is acute and not shooting away from the spine have the greatest probability of having a successful response. Individuals should always be assessed by a licensed health care professional to determine if spinal manipulation is appropriate and should avoid having untrained individuals attempt to “crack” their back.
If you’re someone who is having back or neck pain, schedule an appointment with an FX therapist to start moving and feeling better!
Author: Shaun Baldwin, DPT, OCS
