The vertebral manipulations are known by that gesture that a therapist makes that makes you “crunch” or that “puts” the vertebrae to you. The benefits or indications of the vertebral manipulations are different according to the professional before us. I am going to talk about everything from the medical point of view and what has been scientifically proven. There are some contributions from chiropractors and osteopaths who, while not proven, add interesting things.
Dr. Robert Maigne has been the great scholar of this subject from the medical point of view. Dr. Maigne has carried out numerous scientific studies synthesizing the conditions of the spine in which vertebral manipulations would be useful.
Spinal manipulation is a gesture in which the therapist places certain areas of the back at the end of a passive mobilization, for example by turning the neck to the top. Once arrived at the position the manipulative gesture is realized (taking the movement of brief form and in small route beyond this position). This small controlled gesture produces a click similar to when we make our finger joints sound.
Many times they say things like “I have placed the vertebrae that were misplaced”. This term would not be correct in that it has been shown that the vertebrae do not change position. What does occur sometimes is the unblocking of a vertebral segment that had limited mobility.
Maigne demonstrated the action of manipulations in the treatment of what he called minor intervertebral disorder. It referred to blockages in the posterior joints that generated pain and irradiation. These joint zones are very rich in sensitive nerves and disorders at this level produce characteristic mechanical pains. In the manipulative gesture, the click we hear comes from these joints. If a blocked area is relieved, it has been observed that the muscular contractures accompanying the joint disorder are subsequently relaxed.
There are authors who defend the action of the manipulation in the discal lesions. It is true that during vertebral manipulations there are variations in intradiscal pressure and may play a role in symptomatic relief. Despite this, it has never been seen in imaging tests (such as the scanner) to reduce a herniated disc after a manipulation. On the contrary, there are described accidents that have aggravated a disc injury.
Some therapists use spinal manipulations in the treatment of visceral problems. Although it may have some action on the autonomic nervous system (the nervous system that is responsible for automatic functions such as digestion, sweat, etc.) it is not proven what role can play in this regard.
Regardless of the diagnosis and the injury or disorder that is intended to be treated, the “primum non nocere” which comes to say in Latin must always be present, the first thing is to do no harm . When we apply a treatment like vertebral manipulations where there are benefits but not all demonstrated, it is important to make sure that we do it without risk. From the medical point of view there are some contraindications that must be respected to avoid accidents. Complications are rare but can be potentially very serious especially in the cervical spine. I myself had to attend to a patient who had suffered a serious consequence after a manipulation. This person suffered from a tumor in the spine without knowing it and received a vertebral manipulation that produced serious sequelae. With this I do not want to frighten or discredit this therapeutic gesture because the reality is that these accidents are exceptional. I do want to raise awareness of the importance of going to a doctor when we have a backache. Our doctor can tell us if there are problems in our case or not to receive manual therapies.
What contraindications do vertebral manipulations have?
I will highlight the general contraindications and then those detected by the therapist that make treatment inadvisable.
It is completely contraindicated to carry out vertebral manipulations in cases of tumors, infections, local vascular lesions, bone problems or lesions that can produce compressions (such as vertebral fractures due to osteoporosis). It is also necessary to take into account problems that have been had in previous manipulations that discourage new manipulations like dizziness and dizziness. In active nerve lesions (radiculopathies) caused by a disc herniation, manipulation is not recommended since its benefit has not been demonstrated and there are described accidents in this sense. Discal injuries are not a contraindication in and of themselves.
There are other factors that are not contraindications, but they require caution and risk-benefit assessment, such as taking anticoagulants or recent traumatic cervical lesions where there may be unrecognized arterial involvement.
The therapist must follow a series of rules to avoid accidents. On one side are the medical conditions we have discussed and on the other hand are the rules to follow during the procedure. Maigne described the “rules of non-pain and counter-movement”. This simple sentence is very important. Manipulations should always be done in positions without pain and are performed in the opposite direction to the movement that generated the pain. At the neck level, there is also a simple test to assess the condition of the arteries that pass through the neck and avoid treatment if possible complications are anticipated in this regard.
In summary, vertebral manipulations are a further treatment tool in back ailments that can bring many benefits but are not harmless and require certain precautions, especially in the cervical spine.