A blog from Schubbe Resch Chiropractic and Physical Therapy.

Friday, June 2, 2017

Chiropractic Manipulation of the Cervical Spine

Manipulation of the cervical spine or neck region is a common technique utilized by doctors of chiropractic for many patients complaining of neck, upper back and shoulder/arm pain, as well as headaches. Read more about this first line of treatment for cervical spine conditions.

Types of chiropractic manipulation

The goals of cervical adjustment include reduction of pain, improved motion and restored function. There are two general approaches for cervical spine complaints:
1.                  manipulation-often thought of as the traditional chiropractic adjustment, or a high-velocity, low-amplitude (HVLA) technique
2.                  mobilization – which is a more gentle/less forceful adjustment, or a low-velocity, low-amplitude(LVLA) technique moving the joint through a tolerable range of motion.

A combination of the various approaches varies among patients depending on the chiropractors preferred technique the patients comfort and preferences and the patients response to the treatment as well as both past experience and observations made during the course of treatment.
Adjudicative therapies may include massage therapeutic hear and /or cold application, gentle stretching and strengthening exercises and more

The cracking sound

The HVLA manipulation usually results in a release called cavitation which is created in part by gas escaping from the joint capsule when the joint is moved quickly within its passive range of motion, well within its passive range of motion, well within the tissue boundaries.
This type of chiropractic adjustment creates the typical cracking sound that is often associated with joint manipulation. It sounds similar to cracking one's knuckles.
While this cracking description of a chiropractic high velocity, low-amplitude thrust may give an impression of something that is uncomfortable, many patients find the sensation is relieving and may provide immediate relief of painful symptoms.

Gentle mobilization or adjustment?

There are several reasons a chiropractor may recommend gentle (LVLA) chiropractic techniques, such as:
1.                  Patient preference: some patients do not feel comfortable with the traditional high-velocity thrust manipulation and prefer an approach that does not involve twisting their neck or joint “popping”
2.                  Provider experience: some chiropractors may favor one technique and most chiropractors utilize several approaches and often modify and adapt several techniques to the patient’s needs and preferences.
3.                  Contraindications: some patients may not be able to tolerate the traditional chiropractic adjustment based on past experience or a prior injury or condition.

Gentle techniques

If the patient cannot relax or simply dislikes the cracking feeling or sound a gentle form of chiropractic adjustment may be utilized. Some of these methods include a slower technique performed with in the passive range of joint motion.
1.                  Cervical mobilization – the chiropractor manually moves the vertebra in the neck left to right and vice verse, alternating between the side to side motion and a figure 8 movement, applied at varying degrees of moving the head forward, backward, and to the side and in rotation. This is a smooth, non-thrust type of stretch.

2.                  Cervical manual traction- the chiropractor gently pulls on the neck, stretching the cervical spine often varying the angle between flexion (forward) and extension (backward) based on comfort and searching for the correct angle to most efficiently reduce the tightness.

3.                  Cervical “drop” techniques – the chiropractor places a hand and/or finger over the spinal segment requiring the adjustment. A medium to high velocity, low amplitude thrust, or a non-thrust gradual increasing downward pressure is applied until the drop section/ head piece of the table releases and drops a short distance. The goal is to reduce the fixation or restricted motion of the cervical vertebra assisted by the special table.

Typical cervical problems

                     Mechanical neck pain includes pain generated from muscle, tendons, joint capsules, ligaments and /or the fascia. This type of problem is a common cause of neck pain and stiffness. Most of the time, many of these tissues are simultaneously injured and can cause pain both locally as well as at a distance away from the injury site.
                     Cervical disc problem – tears can develop in the cervical disc and /or the inside of the disc (the nucleus) can herniate through the outer part (the annulus) and trap or pinch the nerve root as it exits the spine.
                     Cervical nerve root irritation can frequently refer pain down the arm and into the hand. Usually affecting specific regions such as the 4th and 5th digits, the palm side thumb to 3rd fingers and/ or the back of the hand on the thumb, index finger side of hand depending on which nerve root is irritated.

                     The above are tow broad examples of types of cervical spine problems that may be treated with cervical spinal manipulation. The patient needs to receive a complete exam prior to cervical manipulation.