Chiropractic Spinal Mobilization Manipulation Techniques and Sciatica

Chiropractic spinal mobilization techniques involve the slow and steady movements of the spine’s joints reestablishing their range of motion. Because it is a slower treatment style the techniques are done with the hands. However, a chiropractor can use various instruments/tools as well. Spinal mobilization treatment has the same focus as spinal manipulation. To get the body back to optimal health and allow the body to heal itself naturally. However, there can be a variety of reasons for utilizing spinal stabilization, with treatment depending on the patient’s needs, if there are underlying conditions, or previous injury/s, and individual preference. Some prefer mobilization because it is gentler and does not generate the pops or cracking sounds. And the chiropractor’s style/specialization comes into play. Some work in the firm manipulation high-velocity style, while others utilize the softer mobilization style and others work in combination.  

Manipulation High-Velocity Low-Amplitude Techniques

This adjustment re-alignment utilizes the necessary force to release the joint out of its restricted motion to improve mobility and reduce pain. There are various types of high-velocity low-amplitude manipulation approaches. These are the more common manipulation techniques:

Diversified Technique

    This high-velocity low-amplitude technique is the one that is commonly associated with chiropractic manual adjustments. The chiropractor applies a short – low-amplitude, quick high-velocity thrust of the restricted joints. This is done one at a time with the objective to restore the normal range of motion. The patient is positioned in various positions to optimize the adjustment/alignment.

Gonstead Adjustment

  The Gonstead technique is another high-velocity low amplitude adjustment. It is similar to the diversified technique. The difference is the evaluation performed to specifically locate the painful joint and positioning of the body as the treatment is performed. Chiropractic or physical therapy chairs and tables can be used to position the patient for optimal treatment, like a cervical chair or a chest-knee table.  

 

Thompson Terminal Point Drop Technique

Here specialized treatment tables with sections that drop down during a high-velocity low-amplitude thrust. The idea is that as the table drops the piece dropped allows for easier movement of the joint. A cracking sound can sometimes be heard. It depends on the patient and their condition. This type of manipulation can also be done in a gentle fashion making it a form of spinal mobilization.  

Spinal mobilization

Slow steady motion/movements are performed to mobilize the joint. Spinal mobilization can be recommended for certain individuals for different reasons like:

• Individual preference for spinal mobilization over spinal manipulation
• Individuals with a sensitive nervous system can benefit from the gentle technique. This can keep the body from experiencing a negative reaction that can cause muscle spasms or other issues.
• Individuals with certain conditions could be given a recommendation for spinal mobilization. This could be:

1. Advanced osteoporosis
2. Bone pathology
3. Spinal deformity
4. Types of inflammatory arthritis

• Individuals in the acute stage of their condition and experiencing severe pain
• Obesity can be a factor as the positioning and the manipulation procedures can be a challenge for the provider and the patient requiring a low force approach.

Mobilization Approaches

The more common spinal mobilization approaches include:

Activator Technique

  The Activator is a hand-held, spring-loaded tool that generates a low-force impulse. A patient lies face down on the adjustment table, while the chiropractor:

• Examines leg length
• Performs muscle testing
• Adjusts the spine and/or extremity joints

Cox Flexion-Distraction Technique

  Here a gentle adjustment is designed to adjust the vertebrae by gently stretching the lower spine. This is usually performed in a series of repetitive slow movements like a steady rocking motion.

Toggle Drop

  Here gravity is utilized to apply the adjustment. The chiropractors’ hands are crossed and on top of each other. Then the chiropractor presses down quickly and firmly on the area of the spine while a section of the table drops. The table sections can be raised and dropped according to the localization of the spinal adjustment.  

McKenzie Technique

  This technique incorporates active patient involvement, empowerment, and self-care as part of the treatment.  

Spinal Release

The chiropractor separates the misaligned vertebrae by applying gentle pressure using the fingertips, with the objective to restore the spine back to a natural position.  

Sacro-Occipital Technique – SOT

This technique utilizes wedges/blocks under the pelvis. This allows gravity with added low-force to assist the chiropractor to realign the pelvis.  

Sciatica Alleviation

All of these techniques can be utilized by a chiropractor for sciatic nerve pain alleviation or can discover other conditions that could be mimicking sciatica.

Nerve mobilization techniques have been recently used as a method to adjust radiating pain related to disc disease, and in particular, mobilization techniques for the sciatic nerves improve mobility of the sciatic nerves, decrease mechanosensitivity of the nervous system, and heighten compliance of nerve tissues, relieving low back pain. Jeong, Ui-Cheol et al. “The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain.” Journal of physical therapy science vol. 28,1 (2016): 46-50. doi:10.1589/jpts.28.46

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