Spinal manipulative therapy is adjustment of the spine using twisting, pulling, or pushing movements.

These movements can loosen and move the spinal bones and joint structures that may be causing pain. This is the basis of chiropractic treatment, but not only chiropractors are trained to do spinal manipulation. See a chiropractor, an osteopathic doctor, a physiatrist, or a physical therapist who performs spinal manipulation. Your insurance coverage may be a factor in deciding who to see for treatment. When deciding about spinal manipulation, consider the following: You may need only home treatment, such as ice, moist heat, pain relievers, and mild e ercise. !or most people, these home treatments usually relieve low bac" pain within # to $ wee"s. %efore you try spinal manipulation, have your symptoms evaluated. &ertain symptoms, such as sharp pain, or low bac" pain with leg pain or numbness, can be a sign of a serious condition that needs immediate medical treatment or that could be made worse by spinal manipulation. You can't count on spinal manipulation alone to treat low bac" pain(. )ood spinal manipulative therapy includes self*care information and strength and conditioning e ercises that help your muscles better support your troubled joints. +f you choose spinal manipulation, find a practitioner who is willing to coordinate care with your other health professionals. What is spinal manipulative therapy for low bac" pain, Spinal manipulative therapy is based on the theory that your spinal health is central to your overall health. +t relies on spinal manipulation, or spinal manual therapy, to increase a joint's range of motion. -ifferent practitioners use different manipulation techni.ues, ranging from massage and slow pressing or twisting to rapid movement or forceful pressure on the head, shoulder, bac", or hips. +f you have tight or spasming muscles, your practitioner may first use a techni.ue such as heat, ultrasound, or electrical current to rela your muscles before manipulating the spine. /ractitioners who are not medical doctors do not use medicines or surgery to treat conditions. /eople who benefit from spinal manipulative therapy usually notice improvement after one visit, and additional manipulation is not needed.0 1t most, 2 to 3 wee"s of spinal manipulative therapy is considered to be enough to treat acute low bac" pain. 1lthough some practitioners encourage long*term spinal manipulation for 4maintenance4 or 4preventive4 reasons, this practice has no proven value. &hiropractors are not your only choice for providing spinal manipulation.5steopathic doctors 6-5s7 are fully credentialed doctors whose training includes an emphasis on manual therapy. Some physiatrists and physical therapists also provide spinal manipulation. 8ealth insurance coverage varies for this type of treatment, so it's wise to chec"*before starting treatment*to find out whether your practitioner of choice is covered. 8ow effective is spinal manipulation, 9i"e other treatments, spinal manipulation helps relieve acute low bac" pain for some people, but not for others. Spinal manipulation success is influenced by both the practitioner's

diagnostic and treatment s"ill, and the cause of low bac" pain. :esults from randomi;ed controlled trials comparing spinal manipulation and placebo suggest that for acute low bac" pain spinal manipulation is more helpful than placebo in the short term. +n the long term 6more than $ wee"s7 there was no difference between spinal manipulation and placebo. !or chronic low bac" pain, the pain improved for more than $ wee"s, but the level of activity was the same as with a placebo.2, 3 &omparisons between spinal manipulation and other low bac" pain treatments have produced conflicting results, but most show that spinal manipulation is no better than usual care such as physical therapy or e ercise.2, 3 1ccording to some e perts, it's difficult to show that one treatment is better than another, because most low bac" pain improves within the first month regardless of treatment.# 1 <&91 study has suggested that people are nearly e.ually satisfied with chiropractic versus medical low bac" pain care when they are given clear treatment information and at least four suggestions for home treatment. 6The study did not include other practitioners such as osteopaths or physical therapists.7= What are the ris"s of spinal manipulative therapy, /erhaps the most common ris"s of see"ing spinal manipulative therapy are related to a lac" of standard practice in this field. %e a smart consumer 6as you would be when considering a surgical or e perimental bac" treatment7. 1s" your medical doctor or physical therapist to e plain the ris"s and benefits of spinal manipulative therapy. /articularly if you have no referral, interview a practitioner or two before starting treatment. Slow 4mobili;ing4 movement has no "nown ris"s. %ut if a practitioner offers to wor" on your nec", remember that forceful nec" manipulation, as performed by some practitioners, has been lin"ed to rare but serious cases of neurological damage and sometimes death. :apid nec" manipulation can injure vertebral arteries, leading to stro"e. +t can also cause disc herniationthat can lead to disability. You can avoid this type of ris" with an e perienced practitioner who uses slow, gentle manipulation techni.ues to treat carefully diagnosed conditions. Tal" to your doctor or physical therapist before trying manual treatment for your nec". +f manipulation leads to increased pain or new pain in the legs or anywhere else, do not continue this treatment. /ractices to loo" for in a spinal manipulative therapy practitioner: +s willing to coordinate treatment with your other health professional6s7 /rovides educational information about home treatment and e ercises -iagnoses musculos"eletal problems with physical e amination and interview, using >*ray in unusual circumstances +s willing to refer you to a specialist when necessary, such as to an orthopedist, neurosurgeon, or oncologist for further testing, or to a registered dietitian for nutritional counseling <ses slow, gentle manual therapy techni.ues /ractices to avoid in a spinal manipulative therapy practitioner: <ses >*rays as a standard diagnostic test, particularly full*body >*rays or >*rays of children, which give unnecessarily high levels of radiation

 /ractices based on the unproven theory that 4sublu ation4 6partial dislocation of two joint surfaces7 is responsible for many medical diseases <ses joint manipulation to treat such conditions as respiratory and ear infections, s"in conditions, eye problems, and learning disabilities /romotes long*term spinal manipulative therapy to prevent illness or joint problems Sells other products or services, such as herbal or dietary supplements or counseling, without proper training and credentials +f you need more information, see the topic 9ow %ac" /ain. Your choices for treating low bac" pain in the first month are: <se home treatment and perhaps wor" with a physical therapist for acute low bac" pain. <se home treatment and see a chiropractor(, osteopathic doctor(,physiatrist(, or physical therapist( for spinal manipulation. See your doctor if you have severe symptoms or symptoms that are getting worse. The decision about whether to try spinal manipulative therapy for acute low bac" pain ta"es into account your personal feelings and the medical facts. -eciding about spinal manipulation:easons to try spinal manipulation for acute low bac" pain You do not have leg pain or numbness. You do not have severe pain. You "now of a reputable practitioner who will coordinate treatment with your other health professional6s7. 1re there other reasons you might want to try spinal manipulation, :easons not to try spinal manipulation for acute low bac" pain You also have leg pain or numbness. You have severe pain, and your doctor has not yet ruled out a serious medical cause. You are uncomfortable with manual treatments that involve physical contact. 1re there other reasons you might not want to try spinal manipulation,

These personal stories may help you ma"e your decision.What +s &hiropractic, &hiropractors use hands*on spinal manipulation and other alternative treatments, the theory being that proper alignment of the body's musculos"eletal structure, particularly the spine, will enable the body to heal itself without surgery ormedication. ?anipulation is used to restore mobility to joints restricted by tissue injury caused by a traumatic event, such as falling, or repetitive stress, such as sitting without proper bac" support. &hiropractic is primarily used as a pain relief alternative for muscles, joints, bones, and connective tissue, such as cartilage, ligaments, and tendons. +t is sometimes used in conjunction with conventional medical treatment. The initials 4-&4 identify a chiropractor, whose education typically includes an undergraduate degree plus four years of chiropractic college.

What -oes &hiropractic for %ac" /ain +nvolve, 1 chiropractor first ta"es a medical history, performs a physical e amination, and may use lab tests or diagnostic imaging to determine if treatment is appropriate for your bac" pain. The treatment plan may involve one or more manual adjustments in which the doctor manipulates the joints, using a controlled, sudden force to improve range and .uality of motion. ?any chiropractors also incorporate nutritional counseling and e ercise@rehabilitation into the treatment plan. The goals of chiropractic care include the restoration of function and prevention of injury in addition to bac" pain relief.http:@@www.webmd.com@pain* management@guide@chiropractic*pain*relief( 8ome &are for 9ow %ac" /ain %ac" pain due to muscle strain will usually get better on its own, but you can ta"e steps to ma"e yourself more comfortable. 1 heating pad or warm baths may provide temporary pain relief.

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Spinal ?anipulation

&hiropractors and some osteopathic doctors use spinal manipulation to treat low bac" pain by applying pressure with their hands to bones and surrounding tissues. This treatment is not appropriate for everyone.Cighty to ninety percent of people in the <nited States will suffer from bac" pain during their lifetime. %ac" pain is the second most common reason for visits to the doctor. +t is also a direct cause of enormous health care e penses. &auses of low bac" pain %ac" strain is by far the leading cause 6BD percent to B= percent of cases7 of low bac" pain in the <nited States. 5ther causes include: 0 -isc herniation: 1 herniated dis" is a rupture of the fibrocartilage surrounding the invertebral dis". /ressure from the vertebrae above and below the dis" s.uee;e the cushioning substance 6nucleus pulposus7 out of the dis". The nucleus pulposus can press against spinal nerve roots. This can be very painful and cause nerve damage if not treated properly. 2 5steoarthritis@spinal stenosis: This is characteri;ed by the constriction or narrowing of the vertebral canal. 3 Spondylolisthesis: Spondylolisthesis is the partial forward dislocation of one vertebra over the one below it. <sually the fifth lumbar is dislocated over the first sacral vertebra. # 1n"ylosing spondylitis: 1n"ylosing spondylitis is a chronic inflammatory disease that first affects the spine and adjacent structures. 1s the disease progresses, vertebrae will fuse together. This disease has a strong hereditary tendency and primarily affects men under 3D years of age. = +nfection $ &ancer A !racture B Eonspinal causes: Eonspinal causes of low bac" pain include abdominal aortic aneurism, "idney stone, infection, or stomach ulcer. -iagnosing and treating bac" pain ?ost bac" injuries will heal with a conservative treatment approach. C tensive testing, including >*rays, ?:+@&T scans, C?)s, and lab tests are necessary in only a small number of cases. +f the pain is caused by trauma, a neurological change, persistent fever, or if the patient is losing weight, one or more of these imaging test may be done immediately. <sually, with conservative treatment, the pain will subside within four to seven days. &onservative treatment includes bed rest 6no more than 2 to 3 days7, acetaminophen 6non* aspirin over*the*counter pain "iller7 or an anti*inflammatory medication, and cold pac"s to diminish swelling and muscle spasm. +f there is no improvement after four to seven days, contact your doctor. :eferences F Eational +nstitute of Eeurological -isorders and Stro"e. 9ow %ac" /ain !act Sheet(. 1ccessed #@23@2D03. 0D 1merican 1cademy of 5rthopaedic Surgeons.9ow %ac" /ain(. 1ccessed #@23@2D03. 00 %hangle S-, Sapru S, /anush :S. %ac" pain made simple: an approach based on principles and evidence. &leve &lin G ?ed. 2DDFHA$:3F3I3FF.

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