We are all familiar with the image of a doctor “cracking” a patient’s spine. There is an audible pop when the joint releases, and there is often an immediate improvement in the patient’s pain and mobility. Many patients are understandably nervous about this treatment, especially when they have arthritis, osteoporosis, or a history of spinal injury or surgery.
While this type of treatment — called manual manipulation, because it is done by hand — may be scary to watch, it is actually very safe. But it also is not the only style of manipulation doctors of chiropractic are trained in.
The key part of the manipulation is the quick, shallow thrust. But the treatment does not have to be done by hand.
Another type of manipulation uses special tables that have built in “drop” sections. These sections can be raised about an inch under the problem area, and when the doctor gives a quick push, the table drops. This allows the doctor to deliver a thrust to the joint that is quicker and gentler than the typical manual style. The resistance can be set by the doctor, with settings ranging from strong resistance for a healthy, sturdy man to a very gentle drop for an elderly patient.
But even that style of manipulation can be too much for some patients. Even gentler is a hand-held tool that delivers a thrust into the joint. Some are motorized, to give a series of thrusts; others are “single shot” designs. What they have in common is the tool’s thrust is much faster than any done by hand, and it also can be more precisely controlled. Because of this, the amount of force needed is much less. This style is often used on seniors, young children, patients in acute pain or those who are really nervous about manipulation.
I recently had a patient in his 80s who had disc surgery in his neck, including a fusion many years ago. Because of his condition, we chose not to do any manual manipulation, or even a drop style, but only used the hand-held tool. He has done very well with this treatment; not only is the pain much better, his neck mobility has increased quite a bit. He feels he is a safer driver now because of the treatment (although I haven’t checked with his wife to see if she agrees).
Yet another style of treatment involves traction for the low back; this is especially useful for back arthritis, any type of pinched nerve such as sciatica, spinal stenosis and disc injuries. In this treatment, the patient is lying face down and the ankles are strapped to the foot of the table. The sections of the table between the abdomen and the pelvis are gently separated, which gives some traction. Then the doctor releases a lock that allows the foot section of the table to be lowered towards the floor, flexing the hips and spine. The doctor holds a pressure against the spine, causing a controlled traction to the low back. For many patients, this is their favorite part of the treatment; if I forget to do it, they remind me.
So don’t let fear of manipulation keep you from getting care. While not all doctors use all these alternative style treatments, we are all trained in alternative ways of treating patients with histories of fracture, surgery or osteoporosis. And manipulation is very safe; one study that compared the safety of this treatment to NSAIDs (anti-inflammatory drugs such as aspirin, ibuprofen, Celebrex, etc.) found manipulation to be literally several hundred times safer than these drugs.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at firstname.lastname@example.org.