Spinal Joint Manipulation: An evidence-based treatment to relieve pain and improve function
By Dr. John Mishock, PT, DPT, DC
How is Manipulation Used in Chiropractic Medicine?
It is estimated that chiropractors treat more than 35 million Americans annually (www.gallup.com, 2018). Manipulation is the primary treatment tool used by chiropractors. Manipulation is a procedure in which a trained specialist (chiropractor) uses their hands or a small instrument to apply a controlled, high-velocity force to the spine or other joints of the body. As a licensed chiropractor and physical therapist, Manipulation is an essential treatment that I use to help relieve pain and improve function. When Manipulation is combined with patient education, therapeutic exercise, and physical therapy modalities, the patient is given the best chance for optimal recovery.
Chiropractors are highly trained physician-level providers with over 4,200 hours or four years of post-graduate training. Ninety-four percent of spinal manipulations are performed by chiropractors, followed by osteopaths at 4%, and physical therapists at 3% (Hurwitz et al. 2020). The most common reasons the general population seeks Chiropractic manipulation is low back pain (50%), neck pain (23%), extremity pain (10%), wellness/maintenance (7.5%), hip pain (7%), headaches (5.5%).
Is Manipulation Treatment Effective?
Manipulation is the most studied treatment modality for musculoskeletal pain, with numerous studies touting its validity, effectiveness, and safety of treatment. For example, in a recent systematic review and meta-analysis in the Journal Spine, 51 research trials comparing Manipulation versus mobilization, exercise alone, modalities, NSAIDS, and standard care showed moderate to high-quality evidence for low back and neck pain. (Coulter et al. 2018) In another comparative-effectiveness trial, 94% of manipulation recipients experienced 54% pain relief compared to 30% of medical care recipients (Schneider et al. 2015)
Chiropractic patients use less medication (NSAIDs, muscle relaxants, oral steroids, and spinal injections) for pain than non-chiropractic users. (Lilledahl et al. 2018) The reduction in medication use leads to less drug dependency and lower healthcare costs. The cost of musculoskeletal pain is estimated at $560-$635 billion annually (Gaskin et al. 2011). Numerous studies have shown Manipulation to be up to 50% more cost-effective with better outcomes than primary care physicians, orthopedists, pain management, and acupuncturists. (Pines et al. 2022) The American College of Physicians guidelines recommend first using non-drug treatments, such as spinal Manipulation, for acute and chronic lower back pain. (Qaseem et al. 2017)
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Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, and “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon and train2playsports.com.
