Neck Pain: Manipulation vs. Mobilization – What’s Better?

Does mobilization (MOB) get less, the same, or better results when compared to spinal manipulative therapy (SMT)? To answer this question, let’s first discuss the difference between the two treatment approaches.

Mobilization (MOB) of the spine can be “technically” defined as a “low velocity, low amplitude” force applied to the tissues of the cervical spine (or any joint of the body, but we’ll focus on the cervical region). This means a slow, rhythmic movement is applied to a joint or muscle using various methods such as stretching.

Spinal Manipulative Therapy (SMT) can be defined as a “high velocity, low amplitude” type of force applied to joint which is often accompanied by a audible release or “crack,” which is the release of gas (nitrogen, oxygen, and carbon dioxide).

Some joints “cavitate” or “crack” while others are less likely to release the gas. Studies that date back to the 1940s report an immediate improvement in a joint’s range of motion occurs when the joint cavitates. Many people instinctively stretch their own neck to the point of release, which typically, “…feels good.” This can become a habit and usually is not a big problem. However, in some cases, it can lead to joint hypermobility and ligament laxity.

As a rule, if only a gentle stretch is required to produce the cavitation/crack, it’s typically “safe” verses the person who uses higher levels of force by grabbing their own head and twisting it beyond the normal tissue stretch boundaries. The later is more likely to result in damage to the ligaments (tissue that strongly holds bone to bone) and therefore, should be avoided.

Since SMT is usually applied in a very specific location (where the joint is fixated or “stuck”, or, partially displaced), it’s obviously BEST to utilize chiropractic, as we chiropractors do this many times a day (for years or even decades) and we know where to apply it and can judge the amount of force to utilize, especially the neck where there are many delicate structures.

Back to the question: Which is better, MOB or SMT? Or, are they equals in the quest of rid of neck pain? A recent study of over 100 patients with “mechanical neck pain” (strain/sprain)  showed that those who received SMT had a significantly better response than the MOB group as measured by a pain scale, a disability scale and 2 tests that measure function!

In our clinic (Denver Chiropractic Center) we’ve found that the best approach uses BOTH. Mobilization in the form of Active Release Technique combined with safe and gentle (never forced) adjustments get better results in a shorter time frame. It all starts with the initial exam, so call us to schedule yours – 303.300.0424.

Carpal Tunnel Syndrome treatment at Denver Chiropractic Center – How can our Active Release Techniques (ART) treatment help you?

Carpal Tunnel Syndrome (CTS) is a very common problem. The American Association of Orthopedic Surgeons (AAOS) reported that in 2007, there were 330,000 carpal tunnel release surgeries performed. (WHOA!) The main reason to have the surgery is to “open up” the tunnel. That is, the transverse carpal ligament or “floor” of the tunnel is released so the contents inside the tunnel are able to move more freely, reducing the pressure inside the tunnel.

Essentially, this is the goal of any treatment (surgical or not): improving the depth of the tunnel, thus reducing the pressure from inside the tunnel allowing the tendons to slide better as the muscles on the palm-side forearm contract to move the nine tendons that pass through the tunnel and attach to the fingers and thumb.

However, there are non-surgical methods for reducing the pressure within the tunnel that should be first attempted as surgery is always reported to be the “…last resort” for good reason. There can be surgical complications, the effects may be only partial, and there is an average of 30% grip strength loss following the transverse ligament surgical release. So, the question is, how can chiropractic approaches reduce the pressure inside the carpal tunnel without somehow changing the length of the transverse carpal ligament?

By going beyond traditional chiropractic care and using Active Release Techniques (ART), we can often release the transverse carpal ligament by hand, taking pressure off of the nerve and relieving symptoms. We can also address possible muscular entrapment sites for the median nerve, like the pronator teres muscle. These muscular entrapments mimic Carpal Tunnel Syndrome, but can be easily released with ART treatment. In the last 15 years, we’ve helped literally hundreds of patients avoid carpal tunnel surgery by using Active Release Techniques. We don’t claim to have a 100% success rate, as some cases do require surgery. But we believe it’s best to try us first and see what we can do.

The use of a night splint to keep the wrist in a straight or slightly “cocked-up” position is also highly beneficial as the pressure inside the tunnel goes up as much as 6-8x when CTS is present when the wrist bends.

If you, a friend or family member require care for CTS, we would be happy to help. Just call 303.300.0424 to set up your first appointment.

The Whiplash Syndrome: Posture and Exercise

Whiplash can result from a number of causes, not just from motor vehicle accidents.  A fall on the ice or a slippery floor, from a sports related injury, or even at the county fair on one of those rides that throws you around can result in the same type of injury. Whiplash occurs when the head is literally “whipped” either forwards and backwards or from side to side. It can include hitting the head but often does not.

Symptoms vary considerably and therefore the term, “whiplash associated disorders” or WAD has been adopted, based on the clinical presentation of the patient and on the specific tissues injured. Common symptoms include neck pain, loss of motion, headache and sometimes arm pain or numbness resulting in difficulty driving, working, sleeping and concentrating.

Active Release Techniques and adjustments of the neck can be highly effective in the treatment of whiplash associated disorder, and hence, Chiropractic is often the recommended first order of treatment for patients suffering from this condition. We have previously discussed the steps involved when presenting to a chiropractic clinic, from taking a detailed history and performing a thorough physical examination, and well as the many types of treatment options that exist.

Exercise is one of the most important forms of treatment as they can and should be performed multiple times a day as directed by us, so that a return to normal function with no pain can occur as quickly as possible. Presented here are a few VERY EFFECTIVE exercises that we frequently give to patients suffering from WAD:

1 Posture Correction A. Arch the back.

B. Retract the shoulders and tuck in the chin. Hold for 10-30 sec. & repeat.
2 Chin Retractions A. Sit properly.

B. Place your finger next to the chin.

C. Retract head & hold 10 sec. & repeat.
3 Neck Strength

Exercises

 A. Rotate RT using 10% Max.

B. Repeat to LT hold 5 sec.

 Repeat this moving the head Forwards, backwards, & sideways in a similar way!*
  • For #3, ALWAYS apply a push or resistance with your hand through the FULL range of comfortable motion in that plane. That means, in one direction let the head “win” (like in arm wrestling) and when moving in the opposite direction, let the hand “win,” (but don’t let up pushing with the head).  In other words, you are ALWAYS resisting against the movement in both directions moving as far as you can in both directions.

We work with patients who’ve been in car accidents and work accidents, and accept all auto insurance, including Med Pay. We also take most major health insurance plans. Are treatment plans are focused on solving the problem, not extending the case. If you’re suffering from accident injuries, call us today at 303.300.0424. We can help.