Spinal Manipulative Therapy

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Spinal manipulative therapy


Spinal manipulative therapies are those that are used on the human skeleton, particularly the spinal area, to relieve muscular or skeletal pain , relieve tension, improve the mobility of joints and, in the case of the oriental therapies, to "unblock energy channels." The idea behind spinal manipulation is that when the vertebrae are subluxated (misaligned), the resulting pressure on nerves can have negative effects on organ system function and general health, in addition to impeding proper joint motion.


Forms of manipulative therapy have been used for thousand of years in Asia. The nineteenth century, however, saw the introduction of many new forms of manipulative therapy in the West. The best known and most widely used of these approaches are osteopathy and chiropractic . Most areas and societies have some tradition of manipulation or massage and osseous adjustments.


Osteopathy and chiropractic in particular have been used to relieve spinal pain and immobility. Both of these therapies can be used in cases of a "slipped disk," and are also used after accidents or surgery to restore mobility. Osteopathy and chiropractic can treat problems of the bones, muscles, joints, or ligaments. They have been used in the treatment of headaches of nervous origin, and even osteoarthritis . Athletes and dancers commonly seek osteopathic or chiropractic treatment for sports or occupational injuries to restore function.


A common practice among the spinal manipulative therapies is that the therapist will generally work on patients while they are lying on a special treatment couch adjusted to the height of the practitioner. The therapies vary from light touching to fairly vigorous manipulation.

The cost of treatment across the various disciplines varies a great deal according to the practitioner's level of qualification, the area of competence, and other factors.


Osteopathy was founded by an American doctor, Andrew Taylor Still . He applied his engineering study and detailed knowledge of human anatomy to the treatment of the human body. He deduced that since misalignment of the skeleton could cause illness, manipulation could theoretically restore good health. The manipulative techniques that Still recommended are commonly referred to as Osteopathic Manipulative Treatment (OMT). OMT is a form of noninvasive, "hands-on" care used for prevention, diagnosis, and treatment to reduce pain and restore motion, as well as help the body heal itself. OMT may be used to facilitate the movement of body fluids and normal tissue functioning, and release painful joints or dysfunctional areas. These therapies take different forms depending on patient needs. In addition to OMT, Dr. Still emphasized the importance that a nutritious diet and overall physical fitness play in maintaining good health. Osteopathy is now widely accepted by the allopathic medical profession, to the extent that they often refer patients to an osteopath. In fact, as of 2002, osteopaths were the fastest growing segment of the total population of physicians and surgeons in the United States.


Chiropractic was developed by a "magnetic healer," Daniel David Palmer, who founded the Palmer School of Chiropractic. This therapy aims to treat pain and other disorders caused by misalignment of the skeleton with manipulation. Upon consultation with a chiropractor, the patient will be asked for a detailed medical history. The chiropractor may take a set of x rays to obtain a more accurate picture of the condition of the patient's spine. The consultant will decide what form the treatment should take, and treatment will begin on a subsequent visit.

Conditions that may benefit from manipulative treatment:

  • whiplash injuries
  • immobility of the spine due to arthritis
  • strain injuries
  • immobility due to previous injuries
  • muscular problems
  • sciatica
  • poor posture
  • tinnitus
  • neuralgia
  • partial paralysis due to stroke
  • cerebral palsy


Generally, no special preparation is required prior to treatment with the various kinds of spinal manipulative therapy, but some practitioners insist on x rays before treatment.


The licensing credentials of spinal manipulation practitioners should always be checked. They should also be given any information regarding the health of the patient that may be relevant to treatment.

Side effects

In the presence of serious spinal problems, damage could result if the practitioner is not properly qualified. A registered practitioner should always be consulted, and should be made aware of all relevant patient information.

Research & general acceptance

Osteopathy and chiropractic are now well accepted as options for the treatment of back pain and many types of sports injuries. The field of sports medicine has found particular benefit in osteopathic practitioners because of their emphasis on the musculoskeletal system, manipulation, diet, exercise , and fitness. Many professional sports team physicians, Olympic physicians, and personal sports medicine physicians are doctors of osteopathy (DOs).

Training & certification


Fully qualified osteopaths undergo four years of post-collegiate training in a college of osteopathy. They must pass state licensing examinations, and are entitled to use MRO (Member of the Register of Osteopaths) after their name. A DO is one of only two types of qualified physician in the United States, the other being an MD (allopathic physician). DOs are qualified to practice surgery, prescribe medications, and offer the same health care services that their allopathic counterparts are. The chief difference between the two groups of physicians is that MDs are more likely to enter specialized branches of medicine, while most DOs enter primary care practice.

Many aspects of traditional osteopathic philosophy, such as advice about diet and smoking , have entered mainstream medicine to the point that the lines between DOs and MDs are blurring. In addition, the dedication of osteopaths to holistic medicine and primary care has been a great benefit to rural areas of the United States that are often understaffed by mainstream practitioners.


Chiropractors are required to take two years of college with a relevant biological curriculum, and four years of resident study that must include supervised clinical experience. A further two years of practical or clinical studies is required, which must include diagnosis and disease treatment.

The Council on Chiropractic Education (CCE) and its Commission on Accreditation is an autonomous national organization recognized by the United States Department of Education as the authority on the quality of training offered by colleges of chiropractic.



Shealy, Norman C. Alternative Medicine, An Illustrated Encyclopedia of Natural Healing. Boston, MA: Element Books, 1996.


"Osteopathic Manipulative Treatment May Benefit Patients." Health & Medicine Week (October 8, 2001).

Shepard, Scott. "Health Philosophies on Common Ground." Cincinnati Business Courier 18 (November 9, 2001): 38.


American Association of Colleges of Osteopathic Medicine. 5550 Friendship Blvd., Suite 310, Chevy Chase, MD 20815-7231. (301) 968-4100. <http://www.aacom.org>.

The American Chiropractic Association. 1701 Clarendon Blvd, Arlington, VA 22209. (800) 986-4636. [email protected] <http://www.amerchiro.org>.

American College of Chiropractic Consultants (ACCC). 28 E. Jackson Bldg., 10th Fl., Suite 1020 Chicago, IL 60604. <http://www.accc-chiro.com>.

American Osteopathic Association. 142 East Ontario Street, Chicago, IL 60611 (800) 621-1773. [email protected] <http://www.aoa-net.org>.

American Osteopathic Board of Neuromusculoskeletal Medicine. 3500 DePauw Boulevard, Suite 1080, Indianapolis, IN 46268-1136.

The General Council and Register of Osteopaths. 56 London Street, Reading, Berkshire RG1 4SQ, United Kingdom.

Patricia Skinner

Rebecca J. Frey, PhD