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.