David R. Beatty, DO, Professor of Osteopathic Principles and Practice, WVSOM
Camilia Makyhoun, Assistant Editor, WVSOM Class of 2016
Thursday, February 14, 2013
TO POP OR NOT TO POP?
That is the question facing those who want to treat their own backs and necks. People say with good reason that there's only one thing better than spinal manipulation and it isn't chocolate. Adjustments that move the joints in the neck and back have been demonstrated to relieve pain, reduce muscle spasm, and improve motion for both the area being treated and neurologically related structures. There's just one catch: Spinal manipulation of the popping variety has a greater risk for side effects and, to a lesser extent, complications than other types of treatment.
Prone thoracic thrust (not for home application)
On rare occasions, sciatica (back pain going to leg) gets worse after a lumbar thrust like the one pictured in the previous post (For Every Manipulation There is an Exercise..."). This can be avoided by stopping the technique if symptoms start to worsen. Rib fractures have occurred with upper back adjustments like the prone thoracic thrust and can be prevented by limiting popping techniques when there is osteoporosis. Tension headaches that sometimes worsen after a neck mobilization can be avoided by doing a position of ease or myofascial stretch before the joint mobilization.
Cervical rotation thrust (not for home application)
The vertebral artery has a twist at the upper neck
(David R. Beatty, drawing by William A. Kuchera, DO, FAAO)
More concerning is a kind of stroke called a vertebral artery dissection that has been reported following neck adjustments. These are believed to occur because of a stretch injury to the blood vessel as it twists up through the cervical vertebrae to get to the back of the brain. A small tear in the lining of the artery causes a clot to form that can then travel up to the cerebellum to block blood flow, resulting in dizziness, nausea, and uncontrolled eye movements. A few deaths have even been reported, both with adjustments and spontaneous head movements. For this reason self-administered neck joint popping by sudden movement is not recommended in any circumstance. A cervical joint mobilization by sidebending articulation (slow movement through range of motion) will be presented in the post on neck and head pain. Prevention of other side-effects and complications will be emphasized for each individual region of the body in subsequent posts.