When I began my physical therapy career almost ten years ago, my prior beliefs and PT school education left me with the impression that spinal thrust manipulation was a dangerous treatment technique. The only acceptable use for it was in 18-30 year olds in pristine physical condition, and only after all other treatment options had been exhausted. Moreover, manipulating the neck was tantamount to setting someone up for instability or a stroke, and thus should never be done. And even if people reported that spinal manipulation was helpful for them (i.e., chiropractic patients), it was only a short-term fix that made the patient dependent on their provider.
What a difference a decade makes! As I began to “unlearn what [I had] learned” (see next post) through clinical practice and literature study, I began to realize that my treatment approach was changing. I noticed that progress for patients treated with massage, stretching, and exercise was evident although noticeably slow. And it was certainly not curative, no matter how diligent they were with their HEP.1
Not only was patient progression not measuring up to what I had learned in PT school, but satisfaction with my career started to wane. It felt that everyone got the same cookbook approach of exercise and massage, with little done to try to be more specific in how I treated pain. It was at this point that I began to look into spinal manipulation as a treatment option, although I still had some reservations about its safety and long-term effectiveness.
During my spinal manipulation training I reviewed, and learned additional, screening tools for pathology not appropriate for physical therapy. But due to my concerns of hurting my patients with the “dangerous” technique of spinal manipulation, I now used the tools much more consistently to protect them (and, honestly, myself from litigation). Later, as I noticed clinically (zero serious events) and empirically2 that adverse events were no more likely to occur with manipulation (even for the elderly with co-morbidities), it became more apparent that I should have been using these screening tools before applying exercise, massage, or any other treatment technique. And as a result, patients have appropriately received (or not, this is just as critical!) diagnostic studies and referrals in a more evidence-based fashion.
In short, I believe that spinal manipulation has helped me be a more effective AND safer provider for patients with painful musculoskeletal conditions.3-6 I have designed my thrust joint manipulation series to provide you with the same blueprint for your professional growth. Reach out to IMMT if you have any questions, or visit our YouTube channel to get a sample of our teaching techniques. For more information contact us today!
References:
1. Nicolson PJA et al. Effects of covertly measured home exercise adherence on patient outcomes among older adults with chronic knee pain. J Orthop Sports Phys Ther 2019;49(7):548–556. doi:10.2519/jospt.2019.8843
2. Geiser MB et al. Adverse events associated with cervical spine manipulation: a literature review: OPO73. J Orthop Sports Phys Ther 2016; 46(1): A88–A89.
3. Dunning JR et al. Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2012;42(1):5–18.
4. Dunning JR, Buck DB et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskel Dis 2016;17:64. DOI 10.1186/s12891-016-0912-3
5. Bronfort G et al. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J 2004;4:335–356. 6. Walser RF et al. The effectiveness of thoracic spine manipulation for the management of musculoskeletal conditions: a systematic review and meta-analysis of randomized clinical trials. J Man Manip Ther 2009;17(4):237-246 DOI: 10.1179/106698109791352085
6. Walser RF et al. The effectiveness of thoracic spine manipulation for the management of musculoskeletal conditions: a systematic review and meta-analysis of randomized clinical trials. J Man Manip Ther 2009;17(4):237-246 DOI: 10.1179/106698109791352085
