Physical Therapy Review: Back and Neck Mobilization

During an average day, most of us probably run into a person with neck or back pain.  Some are chronic, some acute.  The question that always follows is, What makes it better? Are we utilizing short term reliefs such as hot/cold packs, pain medication, and tissue massages?  If so, you can expect your pain to come back.

This subject matter is close to home to therapists, as there are many schools of thought.  We are clinical experts in spinal mobilization and manipulation with Doctor of Physical Therapy degrees from the University of Pittsburgh and our continuing education in Orthopedic Manual Therapy.  The blinded review study we reviewed took 35 separate studies that compared manipulation with multiple other interventions.  From their research they found a report that 80% of people will experience back pain.  So what can we do about it?Unfortunately, the researchers found that most of those studies were of poor quality with decreased control and too many variables.  However, in recent years, that research has improved through Evidence Based Practice.

So what are the good studies saying?

Good research says that the treatment must be matched with the problem.  And often, that problem is regional in nature.  In general, you will get physical therapists to agree that core strength and healthy mechanics will help correct and relieve pain.  There are schools of thought that say any spinal problem can be fixed with repetitive movements to correct spinal dysfunction.  You can find these interventions in "How To Treat Your Own Back".   In general, the new school of thought moves away from this older book.  Now, it is often deemed appropriate for the physical therapist to correct the spinal dysfunction through manipulation and then follow up appropriately with movement or stabilization based programs.  As mentioned, regional consideration is important since rarely is your pain only related to dysfunction at the "exact" area.  Many people experience back pain from problems in their hips and thoracic spine, while many people experiencing neck pain have thoracic spine and shoulder girdle deficiencies.  Most likely, if you have neck and/or back pain would you benefit from manipulation/mobilization?

Primarily, the answer is Yes.  Here are a few more points, if movement is unequal in the neck or spine, meaning less rotation or bending of one side of the spine when compared to the other, then the manipulation's likelihood of success increases. In acute scenarios where spinal movement is affected and back/neck mechanics are affected there is a strong indication to utilize mobilization to return normal movement patterns to that individual.  Additionally, there is evidence that manipulating the thoracic spine can relieve neck pain.  Think of it as making the stand that is holding the vase more stable.  If the thoracic spine isn't working well (wobbly leg of the stand), there can be upstream dysfunction (wobbly stand for your vase).

When experiencing back or neck pain it is important to look at your symptoms.  Are you experiencing pain down the arms or legs?  Are you getting stuck or locked in positions?  Are you unable to move in a certain direction?  These are the questions that lead physical therapists to determine if you will likely benefit from manipulation versus other techniques.  Exercise, traction, and movement based therapies can all be combined with manipulation/mobilization to create the best comprehensive program for you.

Manipulation can be very beneficial in quick relief of back or neck pain and related symptoms.  Looking for a direct access Physical Therapist in your area can allow you to determine what the best option is for you without the wait for a doctor's appointment.  Remember, signs and symptoms like double vision, fainting, and dizziness with your neck pain are likely indicators that a quick fix is not what you need.

Your local physical therapists likely carry orthopedic certifications, utilize them as your musculoskeletal experts.  After all, that is all some of us do!

Credits from this review to:
1. Koes, et al. Spinal Manipulation and Mobilisation for Back and Neck Pain:  a blinded review, BMJ Volume 303. 23/11/1991.
2. NCAAM, "Spinal Manipulation for Low Back Pain". http://nccam.nih.gov/health/pain/spinemanipulation.htm#hed3 . D409. 04/2012.
3. Timko, Michael.  "Mobilization Classification".  Lecture; University of Pittsburgh.  2010.

Partner Perspective: Pike's Peak Hike and Cog Railway Ride

In this segment comparing views of our explorations we will discuss our hike up Pike's Peak Barr Trail (approximately 13 miles one way, 7000 feet of elevation gain) and the Pike's Peak Cog Railway ride on the way down.  Pike's Peak is accessible from Manitou Springs, CO where Ruxton Ave can deliver you to the Barr Trailhead as well as the Cog Railway.  Hiking Pike's Peak is free besides what you pay in decreased ability to breath and exhaustion, the Railway will set you back $35 for a round-trip. 

A Girl's Take

Pikes Peak, nicknamed America’s Mountain, is the second most visited mountain in the world behind Japan’s Mount Fuji.   Over half a million people reach the summit of Pikes Peak each year, but only 3% do so on foot while people take the Pikes Peak Cog Railway or Pikes Peak Highway.

On a sunny summer Sunday, Nick and I decided to join that 3% and hike the Barr Trail to the summit of Pikes Peak.  The 13 mile Barr Trail boasts the greatest base to summit elevation gain among all of Colorado’s  54 14,000er mountains, leading those who traverse it to 14,110 ft above sea level.  For our current work assignments in Colorado Springs, we’re lucky to find ourselves living just 6 miles from the base of Pikes Peak.  Waking up each morning to Pikes Peak’s stunning backdrop is all the more sweeter knowing that we hiked to the top!

Armed with our Camelbaks and some snacks, Nick and I embarked on our journey at the crack of dawn, arriving at the Barr Trail trailhead just as the sun was rising.  Everyone else wanted an early start to their Sunday hikes though because we ended up having to park further downhill in downtown Manitou Springs which added about a mile of climbing just to get to the trailhead. 

As we started our hike I really wasn’t sure what to expect.  To a runner, the idea of hiking, essentially walking for an extended period of time, doesn’t seem that difficult, but when you factor in some steep climbs, rocky terrain, and altitude you get a pretty intense workout.  I must admit that I don’t have much hiking experience and those of you who know me know I’m not much of a hill runner.  Although I’ve completed some hilly marathons in Pittsburgh and San Francisco, hills are not really my forte so I anticipated Pikes Peak would be pretty challenging.  Backpacker magazine also happens to rank the Barr Trail up Pikes Pike among America’s top 10 most dangerous hikes…Pikes Peak or Bust!

Overall, our hike up Pikes Peak was an exhilarating yet exhausting experience.  The first section of our hike consisted of steep switchbacks up Rocky Mountain, a subpeak of Mt. Manitou.  With our legs feeling fresh (for the most part considering we raced a 10k the day before), we made an effort to pace ourselves and to take in the beautiful forests abundant with towering aspens, ponderosa pine, and wildflowers.  After about three miles we passed Noname creek and the trail leveled out for about 4 miles leading us to pick up speed through the gently rolling forests and meadows which offered remarkable rock formations and views of Pikes Peak itself. 

We took our first stop about halfway up the mountain at Barr Camp at 10,200 ft.  We were welcomed by Neal Taylor who has been living year round at Barr Camp with his wife since 2005.  After some chit chat with Neal and some fellow hikers as well as fuel via the Taylor’s famed pancakes and garlic bread we continued on our trek.  We were still feeling pretty good, but I was a little nervous about how I’d feel as we continued to gain altitude so I popped a couple pre-emptive Naproxen. 

After leaving Barr Camp, the trail became steeper and the trees began to get smaller.  This region of very old dwarf trees leads to the tree line.  Tree line, about 3000 ft below summit, marks the entrance into the tundra.  There’s a reason trees don’t bother to grow here…they can’t!  At this point I started to wonder if the trees are smarter than us.  This is where I really began to notice the need for increased effort as well as extra layers of clothing as the temperature began to drop.  As we passed the A-Frame shelter at tree line we were just 3 miles from the summit.  Those final 3 miles took nearly as long as the first 10 miles though!

The final miles to the summit were awe-inspiring, not only in terms of the view but also the amount of effort required to reach the summit.  As the air thinned and the trail became both steeper and rockier I needed a few more rest breaks.  My legs were getting tired, my head felt a little off, I didn’t quite have a headache, but the overall effort is what got me.  I know that I’m pretty fit but my heart was pounding and breathing becoming heavy for what ordinarily wouldn’t cause so much exertion.  I began to feel as though perhaps I’m not as fit as I thought, I felt deconditioned.  Is this how my ICU patients felt when I urged them to walk 50ft?  I took the increased physical demands as an opportunity to slow down for some picture ops and to take in the awesome views.  About 1 mile from the summit we passed the Cirque, an impressive pit carved by glaciers with gorgeous views of lakes to the east.  About half mile from the summit we reached the 16 Golden Stairs, a series of short steep switchbacks.  I’m pretty sure there are a lot more than 16. 

Nearly 7 hours since we started our journey we reach the summit.  The view from the top was spectacular.  The exhilaration of completing such a long and difficult hike coupled with exhaustion from the effort required to tackle the rocky trails and altitude was similar to that of completing a marathon.  In much the same way as you cross the finish line of a marathon full of emotion and pride for your accomplishment and with all of your hard work coming full circle, I reached the summit of Pikes Peak with a sense of achievement and feeling of awe for the view from the top which made all that hard work worth it. 

The panoramic views from Pikes Peak summit were breathtaking (both literally and figuratively I suppose).  In fact, Pikes Peak was the inspiration for “America the Beautiful” written by Katharine Lee Bates, an English professor from Wellesley College who embarked on a cross country train ride in 1893.  Legend has it that upon reaching the pinnacle of Pikes Peak, the words of this poem just came to her.  Katharine wrote them down upon returning to her hotel and years later that poem became the song we all know and love:

O beautiful for spacious skies,
For amber waves of grain,
For purple mountains majesties
Above the fruited plain!
America! America!
God shed His grace on thee…

I reflected on this beauty we are so privileged to take in and the rest of nature’s splendors throughout the world which I hope to see one day, we take a few more pictures, and then our stomach begin to growl and we bee-line for summit house for some hearty stew and hot chocolate…Pikes Peak or Bust!

A Man's Take

A trek up Pike's is a thing of pride.  Many people climb the Barr Trail weekly, but it isn't easy and will earn you a mutual respect that those in Colorado have for nature.  Being an out-of-state transplant to Colorado for this section of our traveling jobs gives a new appreciation for the culture that being connected with Mother Nature creates.  The hike starts with a grueling 3-4 miles of uphill switchbacks that make you wonder what you've gotten into so early.  With thousands of feet to climb your breath leaves you and your butt burns easier than you'd like.  This is a hike to plan ahead of time and make sure you are willing to take on about 10-15 more pounds of weight than your partner ;) because they will be wanting that extra gatorade you brought for them.  Half way up you'll be happily greeted at the Barr Camp run by Neal and Teresa Taylor who will have laid out delicious pancakes and garlic bread for you.  They provide shelther, food, drinks, and supplies for sale year-round above 10,000 feet and only accessible by hike!

  Remember to have a few bucks with you to buy supplies and donate a couple to thank the friendly couple.  Sadly after you say goodbye to some Western hospitality and hit the trail the climbing rejoins you quickly.  The next major stop is the A-frame shelter and the treeline.  At 11,000 feet on Pike's Peak trees don't grow due to the layer of Permafrost at a shallow depth in the soil.  With 3 miles to go the next 2 plus hours will be times when you are forced to site see due to the need for rest.  This is also where you'll find out who is in better shape!  This is where being prepared will make you look smart too.  It is often 40-50 degrees cooler at the top of Pike's Peak than where you started in Manitou Springs.  Don't forget your jacket 7,800 feet below you, Bring layers!  Eventually, with many short stops and a decent amount of complaints from your hiking partner you will be able to traverse the 16 Golden Stairs and summit!

Now is the time to buy beef stew, a famous donut, and hot chocolate.  After you are fully content, it is time to take care of the biggest problem before you, how will you get down?  You can hike down, which becomes a rush just do get back home rather than the awe of  the views that you had on the climb, you can have someone come to the top and drive you down (costs 40 bucks to drive the highway during prime season), or you can take the Railway which provides an 80 minute one-way tour down a different path that crosses Big-Horn Sheep territory and many scenic views.  I would highly recommend the Railway after our trip.  It is an entertaining tour with new scenery and a few jokes mixed in along the way.  No matter your decision on how you'll perform your Pike's Peak journey, make sure you are prepared, up early, and carrying a camera!  This accomplishment is well worth a man point.  Go get your +1.