II. Types
- Counterstrain
- Passive shortening of a Muscle until its associated Tender Point softens while being palpated
- Muscle Energy Technique
- Stretches tight Muscles and fascia by examiner who applies counter force against a patient's contraction
- Soft Tissue Therapy
- Fascial tissue is lengthened through manual force
- Spinal Manipulation
- Manual force applied to spinal joint, moving it at it's end range of motion
III. Indications
-
Acute Low Back Pain
- May offer short term benefit, but no longterm benefit compared with other Low Back Pain Management
- Assendelft (2003) Ann Intern Med 138(11): 871-81 [PubMed]
- Rubinstein (2012) Cochrane Database Syst Rev (9): CD008880 [PubMed]
- Paige (2017) JAMA 317(14): 1451-60 [PubMed]
- Chronic Low Back Pain
- Offers some benefit in the longterm, but no better than other conservative therapy
-
Neck Pain
- Cervical manipulation or mobilization appears effective in reducing pain in acute and chronic Neck Pain
- There are risks to neck manipulation including rare but catastrophic effects (e.g. Vertebrobasilar Dissection)
- Gross (2015) Cochrane Database Syst Rev (2): CD004249 [PubMed]
- Gross (2010) Cochrane Database Syst Rev (1): CD004249 [PubMed]
- Gross (2004) Cochrane Database Syst Rev (1): CD004249 [PubMed]
- Chronic cervicogenic Headache or Tension Headache
- May be effective, but studies of efficacy to date are small
- Cerritelli (2017) J Pain Res 10:601-11 [PubMed]
- Bronfort (2004) Cochrane Database Syst Rev (3):CD001878 [PubMed]
IV. Precautions
- Chiropractic Manipulation is common in infants and children (2.5 Million in 2007)
- Has been used for various complaints beyond musculoskeletal, including respiratory conditions, colic, allergies
- Evidence of benefit is poor in this population, and it is not generally recommended
- Posadzki (2013) Pediatrics 132(1):140-52 [PubMed]
V. Adverse Effects: Serious or Life Threatening
- Vertebrobasilar Dissection (<1 in 20,000)
- Lumbar Disk Herniation (<1 in 2 million)
- Cauda Equina Syndrome (<1 in 3 million)
- Death (<1 in 3 million)
- Nielsen (2017) Syst Rev 6(1): 64 [PubMed]
- Stevinson (2002) Am J Med 112(7): 566-71 [PubMed]
- Vohra (2007) Pediatrics 119(1): e275-83 [PubMed]