Tag Archives: manipulation

Neck Pain: Manipulation vs. Mobilization – What’s Better?

chiropractor san francisco
Neck and Upper Back Manipulation

Does mobilization (MOB) get less, the same, or better results when compared to spinal manipulative therapy (SMT)? To answer this question, let’s first discuss the difference between the two treatment approaches.

             Mobilization (MOB) of the spine can be “technically” defined as a “low velocity, low amplitude” force applied to the tissues of the cervical spine (or any joint of the body, but we’ll focus on the cervical region). This means a slow, rhythmic movement is applied to a joint using various methods such as figure 8, side to side, front to back and /or combinations of any of these movements. In the neck, gentle to firm manual traction or pulling, when applied to the cervical spine, stretches the joint and disk spaces and can be included during MOB. Some consider nonsurgical spinal decompression to be a form of Mobilization. In my opinion decompression therapy is it’s own category.

             Spinal Manipulative Therapy (SMT) can be defined as a “high velocity, low amplitude” type of force applied to joint which is often accompanied by a audible release or “crack,” which is the release of gas (nitrogen, oxygen, and carbon dioxide). Some joints “cavitate” or “crack” while others are less likely to release the gas. This is what a chiropractic adjustment does and is what we do at our San Francisco Chiropractic Clinic.

Studies that date back to the 1940s report an immediate improvement in a joint’s range of motion occurs when the joint cavitates. Many people instinctively stretch their own neck to the point of gas release, which typically, “…feels good.” This can become a habit and usually is not a big problem. However, in some cases, it can lead to joint hypermobility and ligament laxity.  As a rule, if only a gentle stretch is required to produce the cavitation/crack, it’s typically “safe” verses the person who uses higher levels of force by grabbing their own head and twisting it beyond the normal tissue stretch boundaries. The later is more likely to result in damage to the ligaments (tissue that strongly holds bone to bone) and therefore, should be avoided.  Since SMT is usually applied in a very specific location (where the joint is fixated or “stuck”, or, partially displaced), it’s obviously BEST to utilize chiropractic,  as we chiropractors do this many times a day (for years or even decades) and we know where to apply it and can judge the amount of force to utilize, especially the neck where there are many delicate structures.

            Back to the question: Which is better, MOB or SMT? Or, are they equals in the quest of rid of neck pain? A recent study of over 100 patients with “mechanical neck pain” (strain/sprain)  showed that those who received SMT had a significantly better response than the MOB group as measured by a pain scale, a disability scale and 2 tests that measure function! So, the next time you ask the question, “….do you have to crack my neck?,” the answer should be “yes, if you want to achieve the quickest response.” However, if there is sharp pain during the “set-up” of the manipulation or adjustment, modifications in the technique are appropriate or, a different method should be considered.

            We realize that you have a choice in where you choose your health-care services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Special Note: When SMT fails to deliver results, spinal decompression therapy should be considered as a treatment option for back and neck pain secondary to herniated and bulging discs.

To schedule an appointment with one of our Back and Neck Pain Experts in San Francisco, call 415-392-2225.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

More Posts - Website

Follow Me:
TwitterFacebookLinkedInGoogle PlusYouTube

Low Back Pain and Spinal Manipulation: How Does it Work?

chiropractor san francisco
Spinal Adjustment

For many years, Chiropractic has been at the forefront of treating low back pain (LBP) with both greater patient satisfaction and less lost time at work when compared to other non-surgical treatment approaches. There have been many explanations as to why chiropractic manipulation therapy (CMT) works but many of these studies include other treatment modalities or methods and the benefits are ,therefore, not clearly derived only from CMT.  A recent study has tried to clear this up and the results are very interesting!

This study included two chiropractors and two a physical therapists (PT) from Canada and the US. What is unique about this study is that they measured clinical or symptomatic improvement by tracking improvement in activity tolerance using a standard questionnaire commonly used by chiropractors and PTs all over the world, as well as changes in the spinal stiffness using a valid/reliable instrument before and after CMT was utilized. The importance of these findings is that only CMT was utilized and hence, other forms of treatment commonly utilized by chiropractors did not cloud the findings. There were 48 patients included in the study and the initial 2 treatments were administered 3-4 days apart, followed by an assessment 3-4 days after the 2nd treatment. Assessments were also performed before and after each treatment. The assessments included use of the questionnaire and a stiffness measurement using the special instrument. Also, “recruitment of the lumbar multifidus muscle” (a muscle in the low back that helps stabilize the trunk or core) was measured by ultrasound. After each treatment, significant improvement was found in the overall pain level and in reduced spinal stiffness (which remained improved 3-4 days after the last/second treatment).

The study conclusions revealed less pain, more activity tolerance and less spinal stiffness after the administration of the 2 treatments. The greatest clinical improvement was found in those who had the most dramatic reduction in stiffness after each treatment. They found that the level of muscle recruitment was directly related to the degree of spinal stiffness.  They also found that patients who received thrust manipulation (CMT) had immediate improvements with reduced pain, stiffness and improved muscle recruitment measurements. However, this same effect was NOT obtained when non-thrust mobilization techniques were used. This means many non-thrust manual techniques such as mobilization, massage, and other soft tissue release methods do not create the immediate benefits that were produced by thrust manipulation.

With this new information, we are now able to explain with confidence to patients the reasons why they typically feel better after the spinal adjustment. The patient can then appreciate receiving an answer that makes clear sense and has been “proven.” It’s important to realize that the “bonus” of receiving chiropractic care for low back pain includes not only just pain reduction, but more importantly, improvement in tolerating activities such as vacuuming, washing dishes, golfing, walking and of course, working.

            We realize you have a choice in who you choose to provide your health-care services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

To schedule an appointment with one of our San Francisco Chiropractors call 415-392-2225. Mention this blog post for a complimentary consultation.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

More Posts - Website

Follow Me:
TwitterFacebookLinkedInGoogle PlusYouTube