At Upstate Spine & Sport we take a lot of pride in staying up to date on evidence-based chiropractic medicine.
Everything starts with our thorough assessment – it’s the most valuable aspect of what we do for our patients. The assessment helps us determine what tools will best help our patients get better as quickly as possible. From there we lay out a short-term plan to get you out of pain as quickly as possible and teach you how to stay out of pain for the long haul.
One tool that is effective in speeding up that process is the chiropractic manipulation. If clinically indicated, when used in conjunction with specific directional based exercises, soft tissue techniques, and stabilization exercises, long term successes result.
There are many discrepancies when describing the mechanics, benefits, and risks of spinal manipulative therapy (SMT). Chiropractic literature has a plethora of viewpoints regarding chiropractic adjustments, leaving too much room for other professions, personal opinions, and publications to define the chiropractic adjustment.
New studies are published monthly, outlining the benefits of spinal manipulation. Here are some of the most significant studies from 2019 on spinal manipulation.
Safety
In years past, chiropractic manipulation critics pointed to a lack of research regarding effectiveness. Now that overwhelming evidence proves efficacy, critics have drawn attention to safety concerns. New research continues to support the safety of spinal adjustments:
1. Annals of Medicine: “Manual therapy does not result in an increased risk of cervical artery dissection.” (1)
2. There is no increased risk of stroke after spinal manipulation (SMT) of the cervical spine. SMT only produces a fraction of the force needed to tear the wall of a healthy artery. In fact, “strains for the cervical manipulation trials are typically less than 50% of those obtained during normal ROM testing.” (2)
Benefits
2019 has seen dozens of impactful studies regarding the benefits of SMT. Here are two great ones:
1. Researchers from Harvard Medical School, Brigham & Women’s Hospital, and Palmer College of Chiropractic performed a systematic review of the effectiveness of SMT for migraines. They concluded: “We observed that spinal manipulation reduced migraine days as well as migraine pain intensity.” (3)
2. A BMJ study encompassing nearly a quarter-million LBP patients compared initial and long-term opioid use with the choice of initial provider. The study concluded: “Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians.” Drilling beyond the abstract, the data demonstrated that between PT’s and DC’s, chiropractic patients had significantly lower initial and long-term opioid use (0.10 vs. 0.15). (4)
Mechanism
Joint cavitation is one of the key features of HVLA and is considered by most patients and many providers to be crucial for the effective delivery of this technique. i.e., “Did it go doc? I didn’t hear anything that time.” Here are some new facts:
1. Manipulation results in facet joint separation and resultant cavitation; distractive forces are not specific to a particular segment. Manipulation improves range of motion (8-13 degrees in the cervical spine) and results in local pain relief (5)
2. Cavitation is “significantly more likely to occur unilaterally, and on the side contralateral to the short-lever applicator contact during cervicothoracic HVLA thrust manipulation.” (6)
References
- Chaibi A, Russell MB. A risk–benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Annals of medicine. 2019 Feb 17;51(2):118-27.
- Symons B, Herzog W. Cervical artery dissection: a biomechanical perspective. The Journal of the Canadian Chiropractic Association. 2013 Dec;57(4):276.
- Rist PM et al. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis.Headache. 2019 Apr;59(4):532-542.
- Kazis LE, Ameli O, Rothendler J, et al. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open 2019;9:e028633. doi: 10.1136/bmjopen-2018-028633.
- Anderst WJ et al. Intervertebral Kinematics of the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation. The Spine Journal Volume 18, Issue 12, December 2018, Pages 2333-2342
- Dunning J, Mourad F, Zingoni A, et al. Cavitation Sounds During Cervicothoracic Spinal Manipulation. International Journal of Sports Physical Therapy. 2017;12(4):642-654.
** Big shout-out to ChiroUp, a fantastic resource for evidence-based chiropractors. Our chiropractor here in Greenville SC are grateful for your dedication to pushing our profession forward.
