Physiotherapists learn spinal manipulation as part of continuing education courses in Canada. The Orthopaedic Division of the Canadian Physiotherapy Association is responsible for the standards of education and supervises exams required to meet the standards of the International Federation of Manipulative Physiotherapists (IFOMPT).
The Canadian Academy of Manipulative Physiotherapists (CAMPT) is a member organization of IFOMPT and the World Confederation for Physical Therapy. CAMPT promotes research, education and professional standards for physiotherapists practicing manipulative physiotherapy. Fellows of CAMPT have passed Canadian exams to be eligible for membership. FCAMPT physiotherapists are committed to providing the highest quality patient-centred care. Clinical experience is combined with evidence-based orthopaedic practice to achieve clients’ goals.
Physiotherapy Alberta College and Association provides authorization to physiotherapists who have achieved the standards to perform spinal manipulation.
What is Spinal Manipulation?
According to IFOMPT, manipulation and manual therapy are defined below:
Manipulation: A passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit* with the intent to restore optimal motion, function, and/ or to reduce pain.
Mobilization: A manual therapy technique comprising a continuum of skilled passive movements to the joint complex that is applied at varying speeds and amplitudes, that may include a small-amplitude/high-velocity therapeutic movement (manipulation) with the intent to restore optimal motion, function, and/ or to reduce pain.
What joints are manipulated?
The main joint of the spine that is manipulated is the facet joint. The facet joint sits behind the spinal canal and has a close relationship with the exiting spinal nerve. In the cervical spine, the intervertebral segment is also manipulated to influence the “uncovertebral” or U joint.
The thoracic spine has three joints on each side at the back. The facet joint between two vertebrae, the costovertebral joint between the rib and the vertebral Healthy Body and the costotransverse joint between the rib and the transverse process of the vertebra.
Abnormal stiffness of the mid back can influence symptoms in the neck, arms and low back. This area of the spine responds well to spinal manipulation.
The lumbar spine or low back has the largest vertebrae and the facet joints are aligned to protect the spine. These joints usually have less mobility than the spinal levels above.
There are numerous scholarly articles that support the improvement of low back pain with spinal manipulation, click here for more info.
The sacroiliac joint is formed between the innominate or large hipbone and the base of the spine with the fused sacral vertebra. This joint is more vulnerable in women, particularly during pregnancy or postpartum. Women who have had children can remain with more joint flexibility in this area. Manipulation of the sacroiliac joint can provide quick and effective pain relief.
Safety Precautions for Spinal Manipulation
Physiotherapists are required to test for joint stability, nerve and artery function to determine if spinal manipulation is the right treatment choice. IFOMPT has published guidelines to prevent injury to the Vertebral Artery in the upper neck. The Orthopaedic Division curriculum includes tests for the integrity of the joint supports prior to spinal manipulation.
In chronic pain conditions, the tissues around the spinal joint can be very stiff and specific manual therapy may be the treatment of choice to achieve the improved mobility goal. The spinal joint many not respond to the high-velocity thrust of a manipulation.
Informed consent is essential regarding spinal manipulation. Cindy Coneen will discuss the risks vs benefits of spinal manipulation and give you alternative treatment choices for you to be able to make the best treatment choice for you.