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Tag Archives: spinal manipulation

Back Pain Losses

Did you know that back pain is second only to the common cold as the most frequent cause of sick leave?  Back pain accounts for approximately 40% of all work absences.  A study from 1999 found that an estimated 22 million people suffer from back pain that lasts one week or more with an estimated 149 million days of lost work.  So what would those numbers be today in 2017?  Chiropractors are experts on diagnosing, treating, managing and preventing back pain.  If you haven’t had back pain yet, you are lucky, because for most Americans, it is just a matter of time.  Visit the pro’s who handle these problems on a daily basis!!

Enjoying your life to the fullest?

Health is something most people take for granted, however as we age, we start thinking about our mortality a little more frequently. Spine problems are one of those things that can make every day activities more challenging if not addressed. Here are just a few of the problems that can occur with the spine as we age. Degenerative changes of the disc and vertebrae can be a result of genetics, trauma, wear and tear or just life itself. The discs can become thinner, the vertebrae can develop bone spurs. Arthritis can contribute to pain in the spinal joints. Stenosis can occur with a bulging disc or bony changes along the spinal canal. All of the previous can contribute muscle or nerve issues along the spine that can affect the limbs (think sciatica). Chiropractors are educated and trained to diagnose and treat patients with these issues and help them enjoy their daily activities to the fullest. Don’t let spine problems ruin your fun!!


Did you know your skeleton is the frame that all other body systems integrate around.  The spine is the central support column that can suffer with poor posture or other disorders like scoliosis (curvature of the spine).  When the hips are at different heights or the legs are functionally different lengths (leg length inequality), or the shoulders slouch, the spine is forced to carry the body asymmetrically, thus adding to atypical stresses on the muscle and joints of the body, especially the spine and lower extremities. Chiropractic is great for treating people with postural issues or disorders such as scoliosis.  In fact many people have mild scoliosis and probably do not know they have it.  I found out I had scoliosis when I entered Chiropractic College.  My own back issues indirectly led me into the Chiropractic profession and Chiropractic care has helped me maintain my spine.  It works!!

Why back surgery, if it isn’t effective?

Did you know that there is an 80% chance that you will suffer from back pain, if you already haven’t? Did you know that there are 500,000 disc surgeries annually and that most of them are unnecessary and ineffective?  Several studies now indicate that for many patients, fusion surgeries designed to alleviate the pain from degenerative discs, disc herniation’s, and/or radiculopathy do not work. This can lead to significant increase with disability, opiate use, prolonged work loss and poor return to work status. On the plus side, the medical world is now rethinking its approach to back problems because “the world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate”. “There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management.” Dr. Anthony Rosner testifying before of the Institute of Medicine, stated, “Today we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”  Spread the word to your friends and loved ones!

Back pain and bending!!

I never tire of talking to patients about back issues as my own back problem 20 + years ago indirectly led me into the Chiropractic profession.  I recently discussed some back exercises to avoid when one has hurt their back.  Many back injuries are from bending.  Bending forward (flexion) is one of the more common reasons for injuring the discs in your back.  In fact twisting while bending is even worse.  Most spines only have so many bends in them before injury occurs, due to the distortion of the disc fibers that occur with forward flexion.  Sit-ups and crunches are probably one of the worst exercises for acute or sub-acute back problems, until late in the healing process, as that is usually the same motion that caused the original injury.  Please visit your local Chiropractor for help with your low back pain as they are the professionals that understand how to help heal, teach and prevent future problems.

Bending and Spine Pain

Did you know the worst time to bend your back is in the morning?  Back pain comes in many forms and has many causes.  Back pain can go away on its own, but don’t let that fool you.  There is usually an underlying cause and not addressing the cause can mean chronic and life long back issues.  Often times doctors tell patients to strengthen their core muscles to help with back pain.  However, some back exercises shouldn’t be performed as they can make back pain worse.  The most common one is abdominal crunches or sit-ups.  This causes flexion of the spine and puts a lot of stress on the disc material fibers.  The discs of our spine only have so many number of bends before they damage.  This may be different for each individual. The reason not to flex the spine in the morning is that the discs are more hydrated, thicker and more prone to injury.. Limit your bending in the mornings…more later!!

Spine Pain & Lifting

Did you know that most Americans will develop a back problem at some time in their lives?  I’ve discussed this before, however this may put a new twist on things.  Your spine has natural curves for a reason. When you bend out of that natural curve, it really isn’t a big deal, unless it is bearing a load.  That load may be a weight at the gym, a bag of soil or a 3 year old child.  When this happens, it compresses and distorts the discs in the spine and causing the fibers to loosen and divide.  This can allow the nucleus (gel) to leak out between the fibers (bulge/herniation). The only inherent structural stability the spine has is the rigidity of the muscles around it. Without muscles, your spine could not even support your upper body weight.  Basically, we are more likely to hurt ourselves lifting the heaviest or lightest loads. Chiropractic is a great way to help those with back issues and prevent new ones.  More next time!!

Herniated Disc and Chiropractic

Did you know that a herniated disc is a generic term to describe displacement of spinal disc material? A disc can be bulging, protruded, extruded, sequestered, fragmented, or migrated.  They do not slip, contrary to some peoples opinion. Also, 250,000 patients a year undergo elective lumbar surgery for low back disc issues in the U.S.  A study in 2010 compared surgery versus chiropractic care for the treatment of one sided lumbar disc herniation and found 60% of chiropractic patients reported a successful outcome as an alternative to surgery. Finally if you are still on the fence about chiropractic, researchers from another study of 6.6 million patients…that’s correct, 6.6 million,  concluded that there is “no mechanism by which spinal manipulation induces injury into normal healthy tissues has been identified”.   That says a lot about chiropractic care…it is safe and extremely effective!!

Neck Pain and Chiropractic

When it comes to neck pain and Chiropractic care, a systematic analysis of over nineteen hundred studies, researchers concluded that subjects with chronic neck pain, not due to whiplash and without arm pain and headaches, show clinically important improvements from a course of spinal manipulation or mobilization at 6, 12, and up to 104 weeks after treatment.  Another study compared Chiropractic and exercise to drugs and concluded that 30% of both the Chiropractic and exercise groups had no pain at the end of the 12 week of the study compared to 13% of the medication group. If it works, it works, and science proves it!

Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability

By James Brantingham, DC, CCF , Randy Snyder, DC, CCFC and David Biedebach, DC, CCFC

Has the hypomobile manipulable joint lesion been demonstrated to exist?

Historically the manipulable joint lesion has, from the beginning of the chiropractic profession, been described as a painful stiff joint.1,2 Joint stiffness, commonly called hypomobility (also known in the chiropractic profession as “fixation”) has become by consensus one of the most important aspects of the manipulable joint lesion in the professions of chiropractic, osteopathy, and manual medicine.3,4 Nearly 100 years of clinical agreement between three separate professions supports the existence of such a lesion although research now supports its existence.

A meta-analysis of clinical trials of spinal manipulation performed by Anderson et al., clearly and strongly demonstrated that spinal manipulation is effective in restoring or increasing global, and therefore segmental lumbar mobility. Mead et al., documented postmanipulation treatment restored or increased lumbar mobility: data proving that the hypomobile manipulable joint lesion must have existed prior to treatment, and that manipulation restored to these hypomobile joints fuller mobility (Fig 1.).6 Other studies have documented similar results. Nansel and his associates have demonstrated in three, multiply blinded, controlled studies, in which goniometer measurements confirmed cervical range of motion or global end range asymmetries or hypomobility, that after chiropractic high velocity low amplitude manipulation, statistically significant increased mobility was restored to the global and therefore segmental hypomobility areas: proof that global and therefore segmental hypomobility was returned to more normal mobility by manipulation.14-16


Fig. 1
Lumbar Flexion (cm at 6 weeks)
Treated in Hospital Treated by Chiropractor
62 cm 85 cm
(302 patients) (344 patients)
Adapted from Meade et al. 6


Hvidd claimed that prior to manipulation global and therefore segmental hypomobility could be documented by cervical spine stress x-rays; that postmanipulation, global and therefore segmental hypomobility, was returned to fuller or more normal mobility.17 Betge and Leung performed cineradiographic studies and claimed to have documented vertebral joint hypomobility and postmanipulation, to have observed restoration of full or fuller mobility.18,19 Jirout examined 250 patients with pre and posttreatment stress x-rays and claimed that those with hypomobility who received manipulation had improved, fuller, or restored mobility.20 Yeoman utilized 58 case studies performing blinded pre and postmanipulation measurements to document against previously defined normal values that post manipulation mobility was significantly greater than premanipulation data. Yeoman used templating techniques with extension and flexion cervical stress x-rays to document the existence of segmental hypomobility and restoration of mobility to hypomobile joints as well as secondary normalization of hypermobility (Fig. 2).21 Does the hypomobile manipulable joint lesion exist? And can mobility be restored by manipulation? The answer appears to be yes.


Figure 2
Average intersegmental motion before and after therapy. Values for motion or change are ratios of the amount of glide or tilt (horizontal movement) over the sagittal mid-body diameter.
Two examples given:
Male Cases C2 C3
Pre-SMT (average) 0.26 0.27
Post-SMT (average) 0.37 0.37
Normal Values: C2 C3
0.33 0.44
Adapted from Yeoman.21


Can the hypomobile manipulable joint lesion be diagnosed?

Motion palpation as a diagnostic test to determine if a hypomobile joint exists shows mixed results. Some areas of the spine demonstrate degrees of intra and interexaminer reliability and others do not.22 Motion palpation of the spine and sacroiliac joints demonstrate, on balance, marginal to poor interexaminer reliability and good to moderate intrarater reliability.23-28 Manual palpation for vertebral misalignment and muscle tension appears to be unreliable.23 Studies utilizing symptomatic patients point toward greater interexaminer reliability when assessing for osseous and paraspinal soft tissue tenderness23 or tenderness upon palpation of accessory posterior or anterior (joint play) movements.29 In fact, the earliest chiropractic palpation techniques, dating back to founder D.D. Palmer, stressed posterior malalignment, and based upon this, lack of posterior to anterior movement.30,31

As previously noted, stress radiography shows some promise as a diagnostic tool for determining segmental hypomobility,21 as does the goniometer; the goniometer also being capable of documenting restoration of mobility.14-16 As Keating et al., have pointed out, there is a need to evaluate motion palpation using symptomatic, not asymptomatic patient population (as most previous studies have used asymptomatic student populations), and it is therefore too early to draw the firm conclusion as some have that motion palpation is of no value in diagnosing the hypomobile manipulable joint lesion.23 It may well turn out that a combination of diagnostic tests such as palpation for stiffness tenderness, stress radiography, and goniometer measurements will best diagnose the hypomobile manipulable joint lesion. The ability to objectively diagnose the hypomobile manipulable joint lesion has improved but there is still a great deal of room for improvement.

Editor’s note: Part II will appear in the April 22 issue.


  1. Palmer DD. The Chiropractor’s Adjuster: The Science, Art and Philosophy of Chiropractic. Reprinted by the Parker Chiropractic Resource Foundation, 1988. Portland, OR: Portland Printing House, 1910.
  2. Smith OG, Langsworthy SM, Paxson MC. Modernized Chiropractic. Ceder Rapids, MI: Laurence Press, 1906.
  3. Schafer RC, Faye LJ. Motion Palpation and Chiropractic Technique. Huntington Beach, CA: The Motion Palpation Institute, 1989.
  4. Greenman PE. Principles of Manual Medicine. Baltimore: Williams and Wilkins, 1989.
  5. Mellin G. Correlations of spinal mobility with degree of chronic low back pain after correction for age and anthropometric factors. 1987; 12: 464-68.
  6. Meade TW, Byer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment. Br. Med. J. 1990; 300: 14317.
  7. Howe DH, Newcombe RG, Wade MT. Manipulation of the cervical spine — a pilot study. J Royal Coll Gen Practitioners. 1983; 33: 574-79.
  8. Evans OP, Burke MS, Lloyd KN, Roberts EE, Roberts GM. Lumbar spinal manipulation on trial. Rheumatol Rehabil 1978: 17: 46-59.
  9. Rasmassen GG. Manipulation in the treatment of low back pain: A randomized clinical trial. Manuelle Medizin 1979; 1: 8-10.
  10. Waagen GN, Haldeman S, Cook G, Lopez D, DeBoer KF. Short term trial of chiropractic adjustment for the relief of chronic low back pain. Manual Medigin 1986; 2: 63-7.
  11. Zylbergold RS, Piper MC. Lumbar disc disease: comparative analysis of physical therapy treatments. Arch Phys Med Rehab. 1981; 62: 176-79.
  12. Nwuga VCB. Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. Am J Phys Med 1982; 61(6): 273-78.
  13. Anderson R, Meeker WC, Wrick BE, Mootz RD, Kirk DH, Adams A. A meta-analysis of clinical trials of spinal manipulation. J Manipulative Physiol Ther 1989; 12: 419-27.
  14. Nansel D, Jansen R, Cremata E, Ohami MSI, Holley D. Effects of cervical adjustments on lateral-flexion passive end-range asymmetry and on blood pressure, heart rate, and plasma catecholamine levels. J Manipulative Physiol Ther 1991; 14: 450-456.16. Nansel DD, Peneff A, Quintoriaro J. Effective of upper versus lower cervical adjustments with respect to the amerlioration of passive rotational versus lateral flexion and range asymmetries in otherwise asymptomatic subjects. J Manipulative Physiol Ther 1992, 2: 99-105.17. Hvidd H. Functional radiography of the cervical spine. Ann Swiss Chiro Association. 1963; 3: 37-65.18. Betge G. The value of cineradiographic motion studies in diagnosis of dysfunctions of the cervical spine. Bul Euro Chiro Union 1977; 25 (2): 28-43.20. Jirout J. The effect of mobilization of the segmental blockage on the sagittal component of the reaction on lateroflexion of the cervical spine. Neurology, March 1972: 210-215.21. Yeomans SG. The assessment of cervical intersegmental mobility before and after spinal manipulative therapy. J Manipulative Physiol Ther 1992; 15; 106-114.

    22. Banks SD, Willis JC. Spinal manipulation: A review of the current literature. Vol 4, number 3, October 1988: 1-3.

    23. Keating JC, Bergmann TF, Jacobs GE, Bradley DA, Finer DC, Larson DC. Inter examiner reliability of eight evaluative dimensions of lumbar segmental abnormality. J Manipulative Physiol Ther 1990; 13: 463-470.

    24. Panyer DM. The reliability of lumbar motion palpation. J Manipulative Physiol Ther 1992; 15: 518-524.

    25. Haas M. The reliability of reliability. J Manipulative Phyiol Ther 1991; 14 (3): 199-208.

    26. Haas M. Statistical methodology for reliability studies. J Manipulative Physio Ther 1991; 14 (2): 119-132.

    27. Mior SA, King RS, McGregor M, Bernard M. Intra- and interexaminer reliability of motion palpation in the cervical spine. J Can Chiropractic Association 1985; 29: 195-8.

    28. Carmichael JP. Inter-examiner reliability of palpation for sacroiliac joint dysfunction. J Manipulative Physiol Ther 1987; 10: 164-71.

    29. Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophysiol joint syndromes. Med J Australia 1988; 148: 233-236.

    30. Gonstead CS. In W. Herbst, Gonstead Chiropractic Science and Art. USA: SCI-CHI Publications; 1980.

    31. Palmer DD, Palmer BJ. The science of chiropractic 1906. Reprinted by the Parker Chiropractic Resource Foundation, 1988.

    32. Kirkaldy-Willis WH. Managing Low Back Pain. 2nd ed. New York: Churchill Livingstone, 1978.

    James Brantingham, DC, CCFC, Thousand Oaks, California W.
    Randy Snyder, DC, CCFC, La Mirada, California
    David Biedebach, DC, CCFC, Thousand Oaks, California