SPINAL MANIPULATION – NOT AN “ADJUSTMENT”How Does Manual Physical Therapy and Chiropractic Differ?
Spinal Manipulation, also known as ‘High-Velocity Low-Amplitude Thrust’ or ‘Spinal Manipulative Therapy’, is an ancient art and science tracing its origins to the earliest of medical practitioners. Practiced principally by physical therapists and chiropractors, it is also utilized to a lesser degree by medical and osteopathic physicians. Spinal manipulation is unique compared with other manual therapy techniques in that the clinician applies a rapid impulse, or thrust, in order to achieve a gapping and subsequent cavitation of the target joint. Joint cavitation is accompanied by an audible release recognized as a ‘popping’, or ‘cracking’, sound. Spinal manipulation is used by physical therapists to:
· facilitate movement
· relieve pain
· increase circulation
· relax muscles
· improve muscle function
A common misconception is that spinal manipulation by a physical therapist is synonymous with a chiropractic adjustment.
So, the question follows: what is the difference between the two?
Between manual physical therapy and chiropractic? While technique application between the professions can be very similar, the two professions operate under divergent treatment models.
Definitions provided by the Virginia Chiropractic Association are as follows:
Spinal Manipulation: Passive movement of short amplitude and high-velocity which moves the joint into the paraphysiologic range. This is accompanied by cavitation or gapping of the joint that results in an intrasynovial vacuum phenomenon thought to involve gas separating from fluid.
Spinal Mobilization: Passive movements within physiological joint range of motion without cavitation or the popping sound inherent to manipulation.
Definitions provided by the Virginia Physical Therapy Association and the American Physical Therapy Association are as follows:
Manual Therapy: A broad group of skilled hand movements, including but not limited to mobilization and manipulation, used by the physical therapist to mobilize or manipulate soft tissues and joints for the purpose of modulating pain; increasing range of motion; reducing or eliminating soft tissue swelling, inflammation or restriction; inducing relaxation; improving contractile or non-contractile tissue extensibility; and improving pulmonary function. Manual therapy techniques include connective tissue massage, joint mobilization and manipulation, manual lymphatic drainage, manual traction, passive range of motion, soft tissue mobilization and manipulation, and therapeutic massage
Physical Therapy takes a completely different treatment approach, as you will find described in the Guide to Physical Therapist Practice where the disablement model and evidence-based practice are the central themes to our scope of practice.
Physical therapists do not perform ‘adjustments’. We do, however, utilize spinal and extremity manipulation, along with other manual therapy techniques and exercise, in the treatment of neuro-musculo-skeletal pain and dysfunction in order to restore mobility within these systems. We do not utilize manipulation to manage, co-manage, or prevent diseases or conditions in the other body systems.
Perhaps this in itself defines why spinal manipulation is not an ‘adjustment’. And why, although appearing similar on the surface, manual physical therapy and chiropractic are very different animals. The physical therapist’s approach to treatment, whether utilizing spinal manipulation or another manual therapy, is predicated on identifying specific dysfunction—in the spine, pelvis, or extremities—for the sole purpose of achieving clinical improvement within the neuromusculoskeletal system.
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