The most common technique used in Orthopedic Manual Medicine is joint manipulation, mostly vertebral.
Spinal manipulation is a therapeutic intervention that has roots in traditional medicine and has been used by various cultures, apparently for thousands of years.
There is evidence of the practice of spine manipulation in many different cultures spread throughout the world. In almost all cases they are unencrypted empirical techniques, usually transmitted through generations, and have been gradually lost with the development of scientific medicine.
- Europe: Bonesetters in England, Rebouteux in France, Petrikillos in the Basque Country, and so on.
- Latinoamerica: sobadores, hueseros, componedores.
- Hawaii: Lomilomi.
- In Japan and China were better codified techniques and more elaborate, which have survived to this day in some martial arts and global therapies like Kuatsu or Traditional Chinese Medicine.
- In the countries of Arab culture spinal manipulation is also common, within different kinds of massage techniques, complementary to the bathrooms in the hammams.
There are written proof of the usage of these techniques from Antiquity. The Babylonians, Assyrians and Egyptians used a magic-based medicine and the use of plants, but in Greece there are descriptions of the practice of orthopedic medicine for spinal problems.
In Rome there are reports of two authors who quote the benefits of walking on the back, or healing by Galen a cervicobrachialgia through manipulation.
During the Middle Ages, despite the scientific obscurantism prevailed in Europe, we must highlight the existence of these techniques in Islamic medicine developed by Avicenna, largely recovering the works of Hippocrates and whose influence came to hand Spain algebraists .
In the sixteenth and seventeenth centuries the technique of Hippocrates (Ambroise Paré and G. Guidi) was developed. In the eighteenth and nineteenth centuries there was a progressive abandonment of joint manipulation physicians, along with the development of pharmacology. This led to a more common use between empirical healers, like the bonesetters.
Spinal Manipulation Technique
The joint manipulation with thrust may sometimes be somehow spectacular due to its technical difficulty and effectiveness. The type of therapy that arouses interest in the field of manual medicine, being somehow the gesture that gives identity to the discipline .
It is a passive mobilization, forced fast and small amplitude, which tends to bring the elements that form a joint beyond its usual route, reaching the limits of the possible anatomical route. Usually accompanied by an audible click, attributed to a possible vacuum joint phenomenon, and it’s usually painless if properly performed.
The intended effect is pain relief and the restoration of joint’s normal mobility. The disappearance of the pain can be immediate or deferred in a few hours.
Joint manipulations are used primarily at the level of the spine to treat back pain of mechanical origin or benign, but similar techniques are also applicable to peripheral joints.
Mechanism of action of spinal manipulation
Despite the growing number of research studies on the mechanism of action of spinal manipulation, the exact mechanism is still not well understood. What seems clear is that there may be several mechanisms that contribute to its beneficial effect:
- Neurophysiological Reflex
- Gate control
- Endorphine Releasing
Prescribing spinal manipulation will always be determined by clinical diagnosis or segmental intervertebral dysfunction of mechanical origin, responsible for clinical painful as detailed below:
- Cervical Spinal Manipulation: cervical pain, stiff neck, headache of cervical origin, cervicobraquialgias, some dizziness, headaches, shoulder, elbow, wrist or back pain.
- dorsal spinal manipulation: back pain, bone pain, back pain of thoracolumbar origin, abdominal or thoracic celulalgias.
- Lumbar Manipulation: Lumbar acute and chronic lumbago, sciatica, radicular pain and other pain some hip and knee.
- Handling some coccigodinias coccyx.