There are many common misconceptions when it comes to manipulation or “adjustment” (chiropractic language) of the neck. If you watched my recent video you saw and probably heard what are known as cavitations or the “pops” to the joints of the neck. This type of treatment is surely not for everyone, but with the right type of patient the results can be significant. I will leave it up to the physical therapist and their clinical exam to deem who would benefit, but what I want to accomplish with this blog post is to shed some light on some common misconceptions of manipulation so that if you are one of those patient’s that will benefit, you have the confidence to seek treatment.
First misconception, “I don’t want you to hurt my neck.” This is far from concern for the provider, but an understandable perception from the patient’s point of view. First of all, I believe it is the speed of the movement that scares people. Let me explain the benefits of a quick technique. The average duration of this technique has been shown to be around 200 ms. This speed allows the technique to occur faster than the surrounding muscles can activate. This is important because other techniques performed at slower speeds are limited in effectiveness because of muscle guarding. So this speed is crucial as it allows a physiological change to the joint and surrounding structures. The second fear may come from the neck being a high real estate area. This is true, but the manipulation is done in a very safe range and no structure in the neck is even close to being stressed beyond what would normally occur with daily neck movements. One study notes the manipulation only puts the vascular structures of the neck at 6% strain when compared to resting. Rotating the neck to the left and right places these same structures on 13% stress. This means looking out your car window may be riskier than a manipulation.
Second misconception, “I thought only chiropractors did manipulation.” This one is also an understandable misconception. Chiropractic care does often times include a manipulation or “adjustment” as they refer to it. Physical therapists have been performing manipulation for decades and it is a crucial part of our curriculum/education while going through physical therapy school. As a physical therapist the focus of treatment is to correct a movement dysfunction using the most evidence based approaches. This particular manipulation treatment is within a broader group of treatments known as manual therapy techniques or “hands on.” One study looked at the effectiveness of this approach on headaches and within 6 weeks 76% of the patient’s reported at least 50% reduction in pain and at the 12 month follow up their medication intake had reduced by nearly 100%. With evidence like this it is crucial that we as providers are implementing this type of care into our practice in conjunction with other evidence based approaches.
My hope is this answered some questions for you or at least reduced the fear associated with a technique like this. If you could wake up in 6 weeks and have at minimum a 50% reduction in your headache pain and in one year be free of medication, would you do it?