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.
