Data Analysis Chapter: Role of Manipulative Thrust Techniques in the Management of Low Back Pain

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Manipulative Thrust Techniques in Lower Back Pain

Manipulative thrust techniques are used by osteopaths and chiropractors to make adjustments in the lower spinal region of the lower back and other joints in the body. Osteopaths call it adjustments and chiropractors refer to it as manipulation but the techniques are basically the same. Osteopaths use their hands as examining tools to determine the causes of the pain and carry out treatment. Thrust techniques have been used in treatment of lower back, arthritis, repetitive strain injuries, sports injuries, and migraines.

These techniques are being used in shoulder and neck regions in addition to other regions with joints. The techniques are working for some patients and the field seems to be growing. Since documentation on the lower back is limited, other extremities and techniques in the field will be researched as well.

The newer area in the field of manipulative thrust is the manipulative physiotherapist and this field will be examined along with osteopaths and chiropractors.

Data Analysis

Often referred to as "the laying of hands," due to the Osteopaths using their hands to examine and determine the causes of the pain and to administer treatment to the patient. In the early 19th Century, Osteopathy was founded by Andrew Taylor Still, an American doctor, as an alternative to the large amounts of drugs being prescribed by physicians. Still opened his own school for training osteopaths in 1982 in Missouri and a college was opened in London in 1917. In the United Kingdom, over six million people are treated by the 3000 osteopaths practicing there (Inside Track 2010).

Osteopaths require a full medical history before the examination begins and occasionally require x-rays and blood tests. The treatment plan is set up specifically for the individual and average around six to eight sessions. Acute pain can get one or two treatments while chronic sufferers can require an undetermined amount of sessions. Techniques range from high speed thrusts and joint movements to the stretching of tissues and muscles. In the Birmingham Evening Mail (London), 2001 newspaper article, "Inside track: Osteopathy - the laying of hands!; Alternative treatment," the writer reports, "Since last May, all osteopaths must be registered with the General Osteopathic Council. To do this, they must demonstrate via a detailed application process that they are a safe and competent practitioner, have adequate insurance and will abide by a Code of Practice." Improper movements can cause serious damage, paralysis, and even death if neck is broken.

Osteopathic doctors usually have Doctor of Osteopathy (D.O.) behind their names but are educated and medical board certified the same as M.D.s. They can administer prescriptions and can continue their education to perform surgeries. 'Manipulation arose from osteopathic medicine's holistic, or "whole-person," view of the body, namely that nerves, muscles, bones and organs are inter-related' (Ward 2007).

One technique used by osteopaths is the "thrust" which is the slow pulling on the joint followed by a rapid thrust or pull often causing the joint to emit a 'popping' sound. This is associated with chiropractors but the difference is chiropractors work on the spine and osteopaths look at the muscle and bone systems.

Another technique along the same principles is the proprioceptive neuromuscular facilitation (PNF) stretching developed by Herman Rabat. In the article, "The Anterior Cervical Break" (2005), Cooperstein reports, "Kabat had come to the conclusion that herniated cervical discs could simulate herniated lumbar discs, and that the low back and leg pain commonly associated with lumbar spine disorders could also result from cervical spine disorders." Cooperstein does not follow the same techniques as Kabat but has since developed the "anterior cervical break" using a muscle pull and thrust in the a to P. component.

Other similar techniques, but are considered indirect vs. The direct manipulation of the thrust are the strain/counterstrain (CSC) and the positional release therapy (PRT). They refer more to the slight bending and minimal pressure applied to relieving the patients pain (Hammer 2005).

Studies conducted have shown that the thrust techniques do work. One study consisting of 25 males and 45 females suffering from neck pain where divided into two groups. One was the group to receive high velocity low amplitude (HVLA) thrust manipulation and the control group received manual mobilization therapy. The purpose was to determine the relationship between neck mobility and neck pain. The HVLA group showed considerable improvement in rotation of the neck. It was concluded the greater the mobility of the neck, the less the pain (Anonymous 2006).

A randomized controlled study conducted in the Netherlands on 150 participants with pain between the neck and elbow showed considerable results for the use of manipulative therapies. The Dutch had half the group following the normal protocol of home exercises and limited daily usage followed by NSAIDS and analgesics followed with bimonthly injections of corticosteroids. After six weeks they were given physical therapy involving massages and exercises (Better Shoulder 2004).

The other half received six manipulative therapies over the twelve weeks. The techniques used were HVLA and low velocity, low amplitude (LVLA) thrusts at targeted areas to reduce t=restricted movements along the spine and ribs.

The outcomes were taken by use of surveys and analyzing the severity of pain indices. Improvement at six weeks favored manipulation but did not reach full recover until the twelfth week (43% and 21% respectfully). At the end of one year the manipulative group show 52% as recovered and the control group reported 35% (Better Shoulder 2004).

Evidence indicates the use of the manipulative thrust therapies in correlation with regular medical treatment shows that given 12, 26, and 52 weeks to fully recover; the patients respond more favorably to the addition of the manipulative therapy with the normal procedures (Mintken, Cleland, Carpenter, Bieniek, Keirns, & Whitman 2010).

The field of chiropractic medicine is not commonly known to most people in regards to the science behind the field. The study of manual therapy used with common medical practices show excellent results vs. medical treatment alone. The study involves the following details which should not be overlooked:

"Manual therapy" is a term that includes the chiropractic form of manipulation - specific manipulations (low-amplitude, high-velocity thrust techniques) and specific mobilizations (high-amplitude, low-velocity thrust techniques). This is what doctors of chiropractic do, even though a DC didn't deliver the care in this particular study.

The ailments addressed were located in the shoulder. This is the first such study and opens the door for more studies regarding pain in the extremities. Chiropractic researchers should consider performing additional studies to bolster our position as the primary care providers for musculoskeletal health.

The shoulder pain was treated "at single or multiple segmental levels in the cervical spine and upper thoracic spine and adjacent ribs." Manipulations to the spine showed results in reducing shoulder pain and increasing shoulder function. Not a novel concept for chiropractic, but potentially groundbreaking for the rest of the world (Petersen 2004).

The significance of the study showed the manual therapy can be essential to other extremities as well as the spine. The doctor of chiropractic medicine is a unique caregiver and implements a philosophy and therapeutic approach not found in the medical doctors normally seen to treat most ailments (Petersen 2004).

The force exerted during thrust procedure performed by chiropractors can vary at any given time. A study was conducted and the results of the test showed:

"Force and displacement generated during the thrusts were simultaneously recorded and analyzed off line. Peak thrust force ranged from 18.2 to 246N with a mean of 111.2N (SD 48.8). Time to peak thrust force ranged from 20 to 100ms, mean 67.5 ms (SD 13.1). Peak thrust displacement ranged from 6.1 to 28.9mm, mean 24.1mm (SD 4.9) and time to peak thrust displacement ranged from 22.5 to 105ms, mean 59.4ms (SD 13.8). This study demonstrates that the force and displacement induced by any individual practitioner on a simulator can vary by up to 50% during a toggle-recoil thrust," wrote B.A. Graham and colleagues, University of Newcastle, Faculty of Health (Studies from 2010).

Direct practitioners may vary in force by up to 100% and the displacement can be as high as 50%. The variance could been seen as a potential to injury a patient accidentally.

Studies on the amount of force are so being conducted. Christopher Colloca in the article, "Dublin's ESB Conference -- the old meets the new" refers to a new paper he has written,

"Dynamic Response of the Human Lumbar Spine: a five-Degree-of freedom lumped parameter time and Frequency Domain Model, represents a mathematical model of the spine to posteroanterior forces. The utility of such a model allows for calculations of how much motion takes place at the segmental contact point and adjacent vertebrae during a chiropractic adjustment. Allowing for the input of different forces and lines of drive, the model and its animation predict the spinal motion and response to forces applied by the clinician."

The details were not fully discussed in the article but it did note that ultimately chiropractors would be… [END OF PREVIEW]

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