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Spinal adjustment is a term used by chiropractors to describe any of a number of specialized spinal manipulations which are claimed to improve the alignment and/or motion of spinal and extremity joints. The procedures make up the mainstay of chiropractic treatment, but may be supplemented with exercise, electrical modalities and nutritional recommendations.
Many chiropractors believe that spinal adjustment is different from the spinal manipulation performed by physical therapists and osteopaths because the latter never try to improve vertebral alignment when performing manipulations. Despite the differing treatment goals, the actual procedures performed are very similar. Further, any distinction is questionable because of evidence refuting the claim that adjustments reliably restore misalignments (called vertebral subluxations by chiropractors).(Keating) The benefits of any spinal manipulation are questionable: a recent systematic review of systematic reviews of spinal manipulation published in The Journal of The Royal Society of Medicine concluded "Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment."
The most common “adjustment” employed by chiropractors is a high velocity, low amplitude (HVLA) thrust that usually causes an audible popping sound that results from nitrogen gas being released from the synovial fluid found in diarthrodial joints. When an adjustment is performed by a chiropractor, the force applied separates the joint surfaces of the fully encapsulated joint creating a relative vaccuum within the joint space. In this low pressure environment, the naturally dissolved nitrogen found in all bodily fluids turns into a gas and a sound is heard. This gas bubble will remain within the joint for hours while it is slowly reabsorbed by the body. The effects of this treatment include: temporary relief of musculoskeletal pain, shortened time to recover from acute back sprains (Rand) Common side effects include: soreness from minor, treatment induced joint strains, dependency on treatment and neck hypermobility. Less frequent but more serious side effects include: stroke, herniation of intervertebral disks and rib fractures.(Senstad) Serious complications due to manipulation of the cervical spine remain rare, having been documented at 1 in 3 or 4 million manipulations or fewer, but have devastating consequences when they do occur. The current esitmate is based on multiple international studies of millions of chiropractic cervical adjustments spanning from present day back to at least 1965. The "one in a million" estimate is echoed in an extensive review of spinal manipulation performed by the RAND corporation. Less conservative treatments such as neck surgery are also commonly used for conditions very similar to the conditions chiropractors treat using spinal adjustments. In comparison, cervical spine surgery has a 3-4% rate of complication and 4,000-10,000 deaths per million neck surgeries. Particularly alarming was RANDs finding that 80% of all conditions treated with the dangerous neck manipulations were inappropriately prescribed.
Other types of adjustments may include thrusts from mechanical instruments, dropping tables and gentle sustained touches.(Cooperstein) Another problem is the use of elaborate analyses based on questionable rationales because of outdated, incomplete and/or overly simplified biomechanical systems which are relied on to determine the alignment of bones.(Harrison)
Examples of these adjustments include: H.I.O., Toggle, Toggle-Recoil, Palmer, Knee Chest Upper Cervical, Kale, Full Spine, Gonstead, Thompson, Drop Table, Diversified, Activator, Pierce, Pediatric adjusting, Geriatric Adjusting, Pregnancy Adjusting and Extremity Adjusting.
References
Cooperstein, Robert. Technique Systems in Chiropractic. Churchill Livingstone. May 2, 2004.
Harrison, DE. “Three-dimensional spinal coupling mechanics: Part I. A review of the literature." J Manipulative Physiol Ther. 1998 Feb;21(2):101-13.
Keating, J et. al. “In the Quest for Cultural Authority.” Dynamic Chiropractic. December 16, 2004. Vol 22, Issue 26. http://www.chiroweb.com/archives/22/26/09.html.
Powell, FC. "A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain". Neurosurgery. 1993 Jul;33(1):73-8; discussion 78-9.
Rand Group (ed.). “Research Highlights: Changing Views of Chiropractic …and a National Reappraisal of Nontraditional Health Care.” 2001. http://www.rand.org/pubs/research_briefs/RB4539/index1.html
Senstad, Ola et al. “Frequency and Characteristics of Side Effects of Spinal Manipulative Therapy." Spine. 22(4):435-440, February 15, 1997.
See also