Spine manipulation: multi-faceted therapy can correct back or neck problems

When back or neck pain strikes, many people seek out the help of a chiropractor, osteopathic physician or other practitioner of spinal manipulation therapy (SMT). Indeed, SMT (spinal adjustments) can be very effective in the right patient, especially when done by a specialist who’s skilled in the various types of SMT and uses the treatment in conjunction with other therapies, Cleveland Clinic experts say. “It should be a first line of treatment,” says Andrew Bang, a chiropractor with Cleveland Clinic’s Center for Integrative Medicine. “I hate to hear it when a patient comes to me and says he’s had multiple injections and multiple rounds of physical therapy, and no one’s ever recommended spinal manipulation. I think it’s important to give it a shot.” But understand that although SMT is generally safe, it might not always be the best option for you.

Back in balance
Studies suggest that SMT is as good as medications and other treatments at reducing back or neck pain and improving function. Through the application of varying degrees of force and movements, SAT aims to balance the vertebrae and soft tissues of the back and neck into a normal alignment.
“We’re looking for which particular segment of the spine is out of balance and trying to correct that imbalance,” says Fredrick Wilson, director of the Cleveland Clinics Solon Center for Spine Health. “One vertebra should sit atop of another. When a particular (spinal) segment is out of balance, we apply a corrective force and put the segment back into a neutral position.”
When you think about SMT, the more vigorous high-velocity, low-amplitude (HVLA) type
– the familiar “back cracking”
– probably comes to mind. But HVLA is only one of 10 or more
subtypes of SMT, several of which are much gentler. Some forms of SMT are more suitable for certain patients, and your overall health will determine which, if any, type of SMT is right for you. For instance, Dr. Wilson says SMT can be very effective for mechanical-type back conditions, such as sacroiliac joint dysfunction, a problem that occurs where the sacrum (tailbone) connects to the pelvis.
Conversely, he does not use SMT on patients who may have pain caused by nerve inpingement, and he rarely uses HVLA which has been associated with a very low risk of vascular injury, stroke or death when used in the neck. And, HVLA generally should not be used in osteoporosis patients, for whom gentler forms of SMT are more appropriate.

What to expect
During your first visit, your practitioner should review your medical history and symptoms and perform a physical exam to identify the source of your pain and gauge whether SMT is right for you. The specialist also may order an X-ray or other imaging study Some people with acute back pain of recent onset can be corrected and gain relief immediately after one visit. For others with more chronic pain, multiple visits may be necessary. For most people SMT is safe, although you might be sore for a day or two after your first few treatments. How frequently you need to undergo follow-up SMT sessions varies by practitioner and patient. Dr. Bang and Dr. Wilson suggest trying SMT for a few weeks, and if you fail to gain sufficient benefit, consider moving on to other treatments. Both re

commend against agreeing to multiple SMT sessions over a prolonged period. “I tell patients, especially if they’ve had chronic back pain, that we’re going to go with four visits,” Dr. Wilson explains. “If you’re not responding after four visits, there’s something else going on or the manipulation just isn’t going to work, and you have to go in a different direction.”

Help your spine 
As with any treatment for back or neck pain, the amount of relief you gain from SMT depends largely on factors beyond the treatment itself, such as how you care for and support your spine. Smoking, for e.g., restricts blood flow to vital parts of the spine. Sitting for longer periods can not only trigger back pain but also cause long term structural damage to the spine. Try to get up and walk around/stretch every 45 minutes. Other culprits that mess up the spinal alignment are bean bags, high heels, and bad posture.

What you can do
Consider trying spinal manipulation therapy (SMT) in conjunction with physiotherapy, ice, moist heat, pain medications and other conservative treatments for back or neck pain.
Choose an SMT practitioner who is qualified to offer multiple forms of SMT and carefully reviews your medical history to determine which form of SMT, if any, is right for you. Before starting treatment, tell the specialist about any medical problems you might have.
Work with your practitioner to correct any habits (e.g., sleeping, sitting ) that may contribute to your back or neck pain.
If you fail to gain relief from SMT after two to four weeks or about four treatment sessions, consider another treatment for your back or neck pain