Spinal manipulative therapy (SMT) involves moving the head and neck to a firm end-range of movement followed by a fast, thrust aimed at specific joints that are fixed, subluxated (partially out of position), and tender. The thrust is described as a “high-velocity, low amplitude” (HVLA) movement, and it’s also called “an adjustment”, which is more unique to the chiropractic profession. Joint cavitation (the “cracking” sound) often occurs as gas (nitrogen, oxygen, carbon dioxide) either forms within or is released from the joint.
Spinal mobilization (SM) is a low-velocity, low amplitude movement that is typically slow and rhythmic, gradually increasing the depth of a back-and-forth movement, often combined with manual traction. Here, joint cavitation is less common.
Exercise training that focuses on strengthening the deep neck flexor muscles and other exercises that are specifically designed for each individual patient based on their specific needs can result in better treatment outcomes compared to a generalized, non-specific exercise program. Studies in which SMT/SM and exercise are combined report better long-term outcomes than SMT/SM alone, but SMT/SM typically out-performs exercise therapy alone.
Physical therapy modalities (PTM) can include ultrasound, interferential, low and high volt, galvanic current, diathermy, lasers (class 3B and IV primarily), ultraviolet, ionto- and phono- phoresis, pulsed electro-magnetic field, hot/cold, and more.
Muscle release techniques (MRTs) include massage therapy, myofascial release, trigger point therapy, muscle energy techniques, active release therapy, gua sha, and many more.
Cervical traction devices can be used either in the office or at home, depending on the patient’s needs; however, it’s common for both approaches to be used. The obvious benefits of home traction include the ability to repeat its use multiple times a day, and it’s generally more cost effective. Types include static traction that can be applied sitting or supine (on the back) and intermittent traction, which is typically performed supine and is computerized, and hence, is often limited to in-office use only.
Which approaches are used in the course of care depend on the preference of the patient as well as the treating chiropractor. It’s important to discuss your preferences with your chiropractor when seeking care.
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