Spinal Mobilisation

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).

Physiotherapists 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

Manual techniques 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.

The most 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.

Benefits of physiotherapy

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).

References

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.