Spinal mobilisation has always had its efficacy
described in terms of improving mobility in areas of the spine that
are restricted (Korr 1977). Such restriction may be found in joints,
connective tissues or muscles. By removing the restriction - by
mobilisation - the source of pain is eliminated and the patient
experiences symptomatic relief (Maitland).
find spinal mobilisation very effective in a wide range of painful
spinal conditions, particularly where restricted mobility is
present. Restoration of spinal mobility, both in physiological
movement and in vertebral segmental mobility, often results in a
reduction in the patient's pain and spasm. This outcome is equally
effective in the cervical, thoracic and lumbar spine.
Role of physiotherapy
include manipulation, traction and mobilisation. All
physiotherapists are skilled in applying these techniques safely.
For example, physiotherapists routinely assess the integrity of
vertebral artery blood flow before considering an upper cervical
high velocity thrust technique i.e. manipulation.
frequently used mobilisation technique is oscillation. Oscillations
are small, rhythmic movements applied by the physiotherapist to
painful, stiff or inflamed tissue. These tissues include the
zygapophyseal joints, intervertebral discs, dura and spinal nerves.
The comprehensive assessment approach developed by Maitland (1986)
enables the physiotherapist to identify which of these structures is
the primary source of symptoms.
Modern theories propose that spinal
mobilisation can reduce pain by moving swelling containing
neurotransmitters such as substance P and histamine. In addition,
the threshold which stimulates nociceptors may be raised by gentle
oscillations (Melzack and Wall 1986, Wyke 1985, Zusman 1986).
Spinal mobilisation has a significant role to play in the
treatment of neck and back pain. It can be offered as part of a
broader physiotherapy approach which includes aspects of self
management, education and advice or a home exercise program. The
addition of spinal mobilisation to other management approaches to
back and neck problems (analgesia, exercise) gives better outcomes
in terms of reduced pain levels and better physical function (Koes
et al 1992).
||Korr IM (1977): The neurobiologic mechanisms in
manipulative therapy. New York, Plenum Press. |
||Maitland GD (1986): Vertebral manipulation, 5th ed.
Sydney, Butterworths. |
||Melzack R and Wall P (1988): The challenge of pain.
London, Penguin Group. |
||Wyke BD 1985. Articular neurology and manipulative
therapy. (In Glasglow E.F. et al (eds) Aspects of manipulative
therapy 2nd ed. Melbourne, Churchill Livingstone. |
||Zusman M (1986): Spinal manipulative physiotherapy.
Australian Journal of Physiotherapy 32:89-99. |
||Koes BW et al (1992): Randomised clinical trial of
manipulative therapy and physiotherapy for persistent back and
neck complaints: results of one year follow up. British
Medical Journal 304(6827):601-605.
Would you like the names of physiotherapists
who have a special interest in Spinal Mobilisation? This falls
under the category of musculoskeletal. Call us on (03) 9527 7532 or contact us here.
|By courtesy of the Australian Physiotherapy Association