Osteopathy and cervical adjustment
When patients talk about their osteopaths, they generally separate them into two categories: those who crack and those who don’t. These benchmarks are frequently attached to either a positive connotation, or a negative one. For some, it’s a sign of effectiveness, for others, it’s a sign of brutality…
The osteopath, with his or her hands, will find the precise location of the osteopathic dysfunction and will propose the ideal technique in order to offer best results. It is at this point that thrust might be used.
What is an adjustment ?
An adjustment is a manipulation that comes from the structural method. It is sometimes dramatic, not from it’s brisk motion, but from its loud “cracking” sound. The idea is to catch the joint’s physiological defense mechanisms by surprise and create an immediate freeing of cervical mobility.
The implementation of this cervical technique requires the practitioner to find the different lever arms on the spine, in all three dimensions, which are flexion, inclination and rotation.
The barrier to mobility refers to the position of the joint segment that corresponds to the tensioning of the mono-articular muscle spasms that are responsible for the mobility limitation.
Once this tensioning is identified, the practitioner exerts a short, sharp motion with his or her lever arms.
Adjustment provokes the separation of the facet joints, which creates an inverse myotatic reflex, that is, an end to the spasm that allows the joint segment to find the wished-for mobility. The reflexive effect of the normalization has repercussions on vascular circulation as well as the local innervation.
The longtime legal argument that has been used by the medical body against manual therapists is vascular in nature or the vertebral artery is implicated.
We notice that anatomically, the vertebral arteries are susceptible to damage at the level of the C1-C2 (located immediately under the skull), because of the precarious position of these arteries at the heart of the bone segment.
Only rotation, superior to 35o in amplitude obviously creates fragility of the arterial wall.
Rotation and hyperextension (attached photo), according to studies of the vertebral arterial flow risk reaching the contralateral vertebral artery.
Proceed in order to a flexion, a slight inclination and a contralateral rotation (15o to 20o amplitude) return to find the correct barrier to mobility of the cervical dysfunction and avoid its complications.
The Symons study reveals that a normal vertebral artery supports a stretch of 139 to 162% with respect to its initial length. Manipulation brings about a stretch of, on average 6,2% at the level of the C0/C1.
An inescapable clinical exam
The clinical exam is a necessary occasion; it must be systematic and as complete as possible, led by the reason for consultation and the symptoms described by the patient. This exam provides proof to support the hypothesis of the osteopathic diagnosis. It is also necessary that the patient’s consent is obtained and he or she must first be in agreement before cervical manipulation can be done.
- Bones that have been rendered fragile by pathological process.-Signs of nerve compression (marrow, roots…).
- Circulatory problems that follow a reflex arterial spasm or direct pressure.
- An uncertain diagnosis that is due to the absence of the consistency of signs.
- Pain that prevents precise positioning for the technique, and this, for whatever reason.
- Otherwise, all manipulation of the cervical spine in the framework of trauma is prohibited in the absence of a radiological evaluation.
- Inspection of the spine in the frontal, sagittal and transversal plane.
- Palpation of protuberances, processes and myalgic cord
- Percussion of the spiny process
- Active and passive mobility (<60o) of the spine.
- Compression flexion/inclination/rotation
- Compression in the axis
- Valsalva / Cough
- Exploration of cranial nerves
- Lasègue of the arm
- Cervicobrachial neuralgia: Shiva’s test
The said normal values of the arterial pressure measured at the level of the arm are, for a 30 year-old adult: less than 120mmHg for the systolic pressure and 80 mmHg for the diastolic pressure.
For the pulse, certain maneuvers that are meant to reduce the thoracic outlet provoke their disappearance and a murmur at auscultation.c
The radiological assessment lets us know about any earlier diagnostic that is potentially dangerous to the next therapeutic manipulation.
However, a radiological assessment is necessary in the event of a trauma to the cervical spine, whether it is recent, or old and with patients who are 70 years old or older.
The benefits of cervical adjustment
The benefits of cervical manipulation are, on the first hand, of the biomedical order, which harmoniously links the structures and the functions of the body together. It is equally of the postural order, allowing a better static and dynamic stability and to adopt a better standing position.
The biomechanical repercussions
Thrust allows for the elimination of adhesions and the freeing of the synovial meniscus, and allows the joint facets to slide and to restore the joint function, it allows for the normalization of the local vascular system and finally, it allows for the decrease of the intra-discal pressure.
Thrust also stimulates the metamer.
It’s a nerve unit (sclerotome, myotome, dermatome, viscerotome) located around a segment of the spinal cord. Its local excitation influences the part of the autonomous nervous system that corresponds to it, provoking a feeling of general well being!Finally, the neurovascular reflex acts locally to fight inflammation and provokes vasodilation, which increases the vascularization of the ischemic nerve root.
The upper cervical spine and its joints participate in the process of regulation of the body of skeletal muscles and regulate the body’s fine static position, in direct coordination with the sensory organs.
In the long run, thrust improves the insufficiency of ocular convergence and corrects the interaction with the dysfunctions of the central postural system (craniosacral system).
The patient finally experiences less pain and increased mobility.
The relief is immediate or ends after 24 to 48 hours.