Manipulation & Back Pain

This week from Dr. Cerami and Utah Sports and Wellness

From: Canadian Medical Association Journal, July 1958

Quick Summary:

These physicians describe how manipulation can provide back pain relief, even to those patients whom have failed to respond to routine medical treatment. Most symptoms that will respond to manipulation are due to the presence of degenerative disease, which can be managed but not cured. More and more authorities are leaning to the belief that disturbances in the disc mechanism are responsible for the majority of backaches. Studies also show that another common cause of backache is faulty posture. No matter what the cause of back pain, exercises designed to build up the back and abdominal muscles and chiropractic manipulation are of the greatest value. This approach to backache has proved most gratifying and more important, has brought comfort to a large group of patients who have not been able to achieve it before.

Abstract:

A concept of the mechanism of production of many backaches is presented. This offers a rational approach to treatment by mechanical methods-either manipulation or mechanical traction. The selection of suitable cases is discussed and some of the more successful manipulative procedures are outlined. In our hands this approach to backache has proved most gratifying and, more important, has brought comfort to a large group of patients who have not been able to achieve it before.

These authors also note:

• “That manipulation will relieve back pain in many instances, few will argue.”
• Irritation of any of the deeper structures in the back can cause backache together with referred pain. Thus irritation of muscles, ligaments, synovium, dura and bone can cause backache and referred pain.
• In the zygapophysial joints, “adhesions may produce symptoms.”
  • There is a binding of joint surfaces which can be freed by manipulation.
  • A “facet synovial impingement” where there is a “nipping of synovium between joint surfaces” can be relieved by manipulation.
  • A mechanical disturbance of the posterior [facet] articulation can cause back pain
• Low back pain may be due to pressure on the dura mater by a central displacement of the intervertebral disc.
• “By 20 years of age the nucleus has started to degenerate, and by 50 it is pretty well cicatrized [scarred-up, fibrosed].”
• The true sprain of the back “is produced by tremendous force and is a relatively uncommon injury.” [A sprain occurs when the joint goes completely
  through the normal range of motion and then is forced further.]
• Studies show that another common cause of backache is faulty posture, responsible for 5-47%.
• In over 2000 cases whose presenting complaint was pain in the back, or pain that arose from the back, a “diagnosis of disc syndrome was made in over 90%.”
• “Pain coming on instantaneously on a bend or twist is usually considered to indicate displacement of a fragment of annulus that can be manipulated back into place.”
• There are few contraindications to spinal manipulation.
• The main after-treatment in prevention of recurrence is avoiding flexion.
• “All [manipulated patients] are advised to carry out extension exercises while lying on the abdomen. This, it is thought, forces the nucleus and fragments of annulus forwards into the interspace where they do not impinge and are less likely to be protruded.”
• Four manipulation attempts (on consecutive days) is our limit. If the pain is not relieved, the patient is then sent for mechanical traction.
• “Pain so severe as to keep the patient in bed is no contraindication to manipulation.”
• “We see many patients who are afraid to make an effort to get out of bed but who, following manipulation, get up and move with ease.”
• “In our hands this approach to backache has proved most gratifying and, more important, has brought comfort to a large group of patients who have not been able to achieve it before.”