Over the years, chiropractic physicians have developed hundreds of techniques designed to reduce pain and improve function in the body’s musculoskeletal system—particularly in the back and neck. Some of these techniques are manual and some require the use of instruments or machines, but they all involve the application of some type of directed force. Those that use more force or pressure are typically referred to as “manipulation”, while the more gentle types are referred to as “mobilization”.
Spinal manipulation is the traditional chiropractic adjustment approach most people think of when they think of chiropractors. This technique uses a high-velocity, low-amplitude thrust that is directed solely by the practitioner’s hands.
In other words, spinal manipulation uses a specific, sudden force to reposition the vertebrae, creating a popping or cracking sound heard in the joint. This sound—also known as cavitation—is thought to be a release of air from the joint when it is pushed past its regular range of motion, similar to what occurs when people crack their knuckles. Manipulation techniques are widely used to treat everything from back and neck pain to headaches and joint conditions.
In contrast, spinal mobilization techniques are lower-force alternatives that can be used to restore or improve joint function. These techniques use slower movements and less pressure to reposition the vertebrae, typically until the joint can move no further or until the chiropractor encounters resistance.
Many chiropractors favor these lower-force techniques to accommodate certain health conditions and patient preferences. People suffering from some kinds of trauma or chronic conditions that affect the musculoskeletal system (such as fractures, osteoporosis, arthritis, bone cancer or obesity), people who are anxious about treatment (perhaps first-time patients, children or seniors) and people with extreme sensitivity are often good candidates for mobilization.
So, is one approach really better than the other? There’s no simple answer to this simple question. It really depends on the specific needs and preferences of individual patients.
Both spinal manipulation and mobilization share a common goal, which is to reduce pain and to help restore function to affected joints. With this goal in mind, your chiropractor will select the combination of manual therapies that he or she believes will achieve the best result for you based on professional judgment. However, clinical effectiveness is not the only consideration. He or she will decide to use manipulation or mobilization based on a wide variety of other factors as well—including your safety and comfort. Here is a brief summary that you can use as a set of “talking points” in a discussion with your chiropractor:
Patient preferences play an important role in choosing a technique. Some people enjoy gentler types of treatment, while others feel great satisfaction (even an occasional “buzz”) from the cavitation produced during spinal manipulation. It is also common for patients who have previous experience with chiropractic care to know how their bodies react to different techniques and to have specific expectations.
The patient’s overall musculoskeletal health is another important consideration. Some types of prior trauma and health conditions may increase the risk of injury from more forceful spinal manipulation techniques, making them inappropriate. In these cases, low-force mobilization methods may be the best alternative.
Anxiety and fear are variables that can affect the quality of treatment as well as the patient experience. A patient who is anxious or fearful about chiropractic care may “tense up” just prior to receiving traditional spinal manipulation, potentially making the adjustment more difficult and less effective. While an experienced chiropractic physician will anticipate this possibility and can compensate for it in the delivery of the treatment, the use of more forceful techniques can inadvertently reinforce a patient’s anxiety or fear. This may lead a practitioner in the direction of mobilization.
A patient’s general sensitivity to touch can influence a chiropractor’s treatment decisions. People who are particularly sensitive or who are already experiencing a lot of pain may be better candidates for spinal mobilization than traditional forms of spinal manipulation.
Obesity and some types of physical deformities can create special treatment challenges for both the patient and the practitioner. A patient’s body shape or composition may make certain chiropractic techniques less effective, dangerous or impossible to perform. Your chiropractor will use his or her training and experience to develop a safe and effective treatment plan based on your individual situation.
If you have specific questions about chiropractic care—or would simply like to know more about our approach—we invite you to contact our office today!