Basis, indications and risk

Treatments Basis, indications and risk Patient information Postural hygiene Exercise Maintaining level of Activity Bed rest Pharmacological therapy Neuroreflexotherapy (NRT) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

Vertebral manipulation

It consists of maneuvers performed on patients by a specialist to elicit movements of the spinal column. These movements are usually rapid, of short range of motion and only or specially affect a given vertebra.

Objective

Depending on the different kind of practitioners (osteopaths, chiropractors, etc.), the claimed objective may differ:

1. To place a vertebra back in its correct position
2. To relax contracted muscles.

Theoretical base

Some practitioners claim that manipulation is intended for vertebrae realignment, by placing the vertebral in their correct position, and suggest that even minimum displacement of the vertebra -especially rotation- may be an important factor for onset or recurrence of back pain.

Other providers believe that the manipulative effect is felt on muscles and ligaments, and that vertebral displacement is not necessary in order to obtain a beneficial effect. In fact, available studies have not shown changes in vertebral alignment either before of after manipulation, even in patients who improved after manipulation.

Evidence of efficacy

Some of the existing recommendations based on scientific evidence establish that, although there are many studies on the efficacy of manipulation, the majority rank low in methodology scores, so their results cannot be included for review.

In spite of this, some of the existing recommendations advise its use for those patients with:

• Back pain of less than 1 month's duration (according to some) or 1.5 months (according to others). There are no consistent data about its efficacy in patients with pain episodes of longer duration.
• Non-radiating pain. There are no conclusive data on its efficacy in patients with radiated pain.

There are no data on the specific type of patients for whom manipulation is indicated nor the comparative efficacy among the different types of manipulation.

Available studies are consistent in establishing that, in patients with non-radiating back pain of less than one month's duration, vertebral manipulation obtains, in comparison to physical therapy treatments, such as applying heat, cold or massage, similar or better results, with better patient satisfaction, although at a higher cost.

Risks and contraindications

Some of the existing recommendations based on scientific evidence establish that manipulation very rarely produces adverse effects if patients are thoroughly evaluated, if those with potential contraindications are not included and if a well-trained specialist performs manipulation.

Those recommendations establish that vertebral manipulation should not be performed with relevant or progressive neurologic dysfunction.

Indications

In spite of conflicting evidence the recommendations that advise the use of spinal manipulation are for patients with back pain who do not present radiating pain and whose discomfort is of less than 1 month's duration, and point out that manipulation should be discontinued if there is no symptomatic improvement after 1 month.