Chiropractic Adjustment

​A chiropractic adjustment, also known as chiropractic manipulation, manual manipulation, or spinal manipulation, is a common therapeutic treatment for lower back pain.
A chiropractic adjustment refers to a chiropractor applying manipulation to the vertebrae that have abnormal movement patterns or fail to function normally.
The objective of this chiropractic treatment is to reduce the subluxation, with the goals of increasing range of motion, reducing nerve irritability and improving function.

Chiropractic adjustment description

​A chiropractic adjustment typically involves:

• A high velocity, short lever arm thrust applied to a vertebra

• An accompanying, audible release of gas (joint cavitation) that is caused by the release of oxygen, nitrogen and carbon dioxide, which releases joint pressure (cavitation)
• A relieving sensation most of the time, although minor discomfort has been reported (that usually lasts for a short time duration) if the surrounding muscles are in spasm or the patient tenses up during this chiropractic care

It should be known that joint cavitation or cracking does not occur at times, typically as a result of significant muscle splinting or the patient not being adequately relaxed during the chiropractic manipulation. At times like this, it is sometimes best for the chiropractor to apply ice, have the patient rest, or do electrical stimulation and massage prior to attempting the chiropractic adjustment.

Chiropractic adjustment techniques

There are many different manipulative techniques that can be utilized in chiropractic, and there is a certain skill level and "art" involved with high velocity, low amplitude adjustment or manipulation. It is perhaps more important for the chiropractor to determine when not to apply the adjustment.

Chiropractic treatment plan

Goal setting for the chiropractic treatment plan is driven by the patient's pain and disability issues and activity intolerance.
Consistent among all guidelines of low back pain treatment is the prevention of chronicity. The use of active care (care that is patient-driven such as exercise, activity modification, ergonomic modifications, etc.) is emphasized to accomplish this goal.

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References

1.Rubinstein SM, van Middelkoop M, et. al, "Spinal manipulative therapy for chronic low-back pain," Cochrane Database Syst Rev (2): CD008112. doi:10.1002/14651858.CD008112.pub2. PMID 21328304.
2.Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (2010), "NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain," Spine J 10 (10): 918–940. doi:10.1016/j.spinee.2010.07.389. PMID 20869008.
3.Leininger B, Bronfort G, Evans R, Reiter T, "Spinal manipulation or mobilization for radiculopathy: a systematic review," Phys Med Rehabil Clin N Am 22 (1): 105–25 (2011). doi:10.1016/j.pmr.2010.11.002. PMID 21292148.
4.Hahne AJ, Ford JJ, McMeeken JM, "Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review," Spine 35 (11): E488–504 (2010).