If you’ve had pain in your back or shoulder region or neck, then you might have been recommended to a PT for spinal mobilizations.
The terms can sound a bit scary if you don’t know what it means and what’s involved in spinal mobilizations. But it’s a safe and efficient technique that manual therapists use to diagnose and treat common painful conditions of the back.
In this article, we’ll answer your common questions regarding manual therapy and spinal mobilizations. And hopefully, leave you with some valuable information supported by research and scientific literature.
What are Spinal Mobilizations?
Spinal mobilizations are mostly passive movements where spring-like pressure is applied on your vertebrae (small bones of the spine). These can be diagnostic or therapeutic. So if your chiropractitioner, manual therapist or physical therapist starts pressing down on specific regions of your backbone, this is what they’re doing.
Spinal mobilizations are mostly passive movements where spring-like pressure is applied on your vertebrae (small bones of the spine). So if your chiropractitioner, manual therapist or physical therapist starts pressing down on specific regions of your backbone, this is what they’re doing.
As a diagnostic tool, spinal mobilizations help your health care provider check your range of vertebrae motion and spasm of surrounding structures amongst other things. This is also done to establish a baseline of what’s normal for you.
Your low back pain can arise due to hypermobility or hypomobility of the vertebra. These tests can help your PT know what the potential causes are of your pain and treat you accordingly.
It is usually applied to reduce pain and restore the range of motion of the spine. But it has an array of other benefits as well which we’ll cover in detail later in this article.
Who Can Apply Spinal Mobilizations?
You should know that not every healthcare practitioner can apply spinal mobilizations. These are classified under manual therapy when used as a treatment. Only licensed medical doctors, manual therapists, chiropractitioners and physical therapists can use this technique in clinics.
How Long Will I Need Spinal Mobilization Treatment?
Currently, there is no accurate prescription for how long patients should receive spinal mobilizations. So therapists determine the duration and frequency of treatments based on their experience and clinical judgment.
The National Collaborating Center for Primary Care (UK) suggests that for patients with non-specific back pain that has lasted for more than 6 weeks but less than a year, a 12-week manual therapy course can be beneficial.
What Are The Different Types Of Spinal Mobilizations?
When talking about manual therapy and mobilizations you might also hear the term manipulations or thrust force.
Manipulation and mobilization are both joint based manual therapy techniques. Each has a different purpose and is applied a little differently. The manipulations go beyond the normal range of motion of the joint whereas the mobilizations don’t.[i]
Spinal mobilizations are divided into various categories. Some of them are as follows:
Physiological and Accessory Mobilizations
In medical terms, spinal mobilizations are divided into two main categories; namely physiological and accessory.[ii] Both of these are therapeutic and differ only in the amplitude of mobilization.
The physiological movements are slow, controlled forces that should not cause you any discomfort. These have a therapeutic role and as your range improves or stiffness decreases, the amplitude of physiological mobilizations increases. These are also known as passive physiological intervertebral movements (PPIVM).
In the accessory spinal mobilizations, your therapist will move the vertebrae through larger ranges but will stop before the point of pain. These movements are also called passive accessory intervertebral movement (PAIVM).
Four Grades of Movement
The spinal mobilizations are also divided into four grades according to the amount of force applied and the level of displacement achieved.[iii] Each of these grades has a different purpose and should be used specifically for that.
For example, grade 1 is a small amplitude movement for pain relief and grade 4 is also a small amplitude movement but for reducing stiffness. Both of these are applied in different ranges and with varying forces.
Maitland’s Mobilization Types
Another classification of spinal mobilizations is according to the direction of the force. These are known as posteroanterior (PA) glides, anteroposterior (AP) glides, medial glides, lateral glides, joint distraction and so on.
The difference in these is the direction and movement arc. Your therapist will choose one or two based on your symptoms and end goals.
For example, a study by Shum et al. (2012) found that PA lumbar glides had positive effects in treating low back pain with a forward-bending stiffness. Other studies have also established the efficiency of PA glides in reducing pain and improving ROM and disability.
Spinal mobilizations have positive effects in treating low back pain with a forward-bending stiffness. Other studies have also established the efficiency of PA glides in reducing pain and improving ROM and disability.
Some therapists use manual therapy particularly lateral glides to treat scoliosis along with other conservative management, but high-quality studies in this area are lacking.[iv]
Benefits Of Spinal Mobilizations
Manual therapy spinal mobilizations are widely used by different healthcare providers. That’s because these are effective and offer many benefits. Some of which include:
- Increase ROM and decrease stiffness.[v]
- Decrease pain in the back.[vi]
- Improve mobility in the spinal structures. That can be bones, joints, muscles, ligaments and connective tissues. [vii]
- Correction of spinal curves to the anatomical position.
- Treat painful conditions such as low back pain, migraines and neck pain.
How Do Mobilizations Reduce Pain?
There are various studies that prove the effectiveness of spinal mobilizations in reducing pain.[viii]
This technique primarily reduces pain by decreasing the brain’s sensitivity to painful stimuli also known as the hypoalgesia effect. We have several theories that explain the mechanism of this effect. Some of which we’ll discuss here.
But before we do that, it’s important to point out that the pain-relieving mechanism of the body is complex. It involves the interaction of various systems and the exact mechanism is still debated. The theories we’ll touch on here are backed by the research but this is not an exhaustive list by any means.
Also, there are not enough studies to show the long term effects of spinal mobilizations alone in reducing pain. That’s why your therapist will usually prescribe a long term home exercise program to help you maintain the pain-relieving effects of spinal mobilization treatments.
Here are some theories that explain pain reduction mechanisms:
1. Pain Gate Theory
According to the pain gate theory, sensory input from the muscles and joints stops the painful stimuli from travelling up to the brain.
In other words, when your therapist applies the mobilizations, it activates some large sensory nerves in your back which ‘close’ the pain gate and disable the painful messages from reaching the brain.[ix]
2. Activation of a Chain Of Neurophysiological Responses
According to Bialosky et al (2008), a mechanical force similar to the one applied in spinal manipulations activates a chain of neurophysiological responses which ultimately reduces pain.
This response starts at the tissue level with a decrease in muscle spasms that signals the nervous system to decrease inflammatory modules (these are released when the body senses an injury). Then go on to involve the spinal cord and the central nervous system to produce a lasting change.
The researchers also accounted for the changes in heart rate, psychological factors and hormonal response in their comprehensive theory about pain-relieving mechanisms.
3. Different Mediators Act to Reduce Pain
Another theory is that pain decreases after manual therapy because of various mediators. These can be biomechanical, neurophysiological, and hormonal.[x]
A study by Vernon et al. found that spinal manipulations cause a significant increase in serotonin and β-endorphins which increase the feeling of well-being. There are also studies showing a reduction in the pain threshold after joint or muscle manual therapy.[xi]
Biomechanical factors that could decrease pain are an increase in soft tissue extensibility, joint motion, and improved blood flow to the area.[xii]
When Should You Not Get Spinal Mobilizations?
Although spinal mobilizations are effective as we’ve discussed above, there are certain limitations and contraindications of this technique. Here are some conditions when spinal mobilizations are not recommended[xiii]:
- Patients with osteoarthritis
- Tumors, infections, fractures that weaken the bone
- Hypermobile structures
- Pregnant patients need extra precautions
- Deformities such as Spondylolysis
Key Takeaways
Spinal mobilizations are a useful technique used to diagnose and then treat certain conditions. These are classified as manual therapy techniques but many healthcare providers other than manual therapists use them in their practice.
If you have any more questions about manual therapy or spinal mobilizations, then leave them on our contact page or our social media pages and we’ll try to answer them!
[i] https://www.ncbi.nlm.nih.gov/books/NBK338114/
[ii] https://pubmed.ncbi.nlm.nih.gov/19643656/
[iii] https://www.elsevier.com/books/maitlands-vertebral-manipulation/hengeveld/978-0-7020-4066-5
[iv] https://pubmed.ncbi.nlm.nih.gov/30691751/
[v] https://pubmed.ncbi.nlm.nih.gov/12527251/
[vi] https://pubmed.ncbi.nlm.nih.gov/1454864/
[vii] https://pubmed.ncbi.nlm.nih.gov/1454865/
[viii] https://pubmed.ncbi.nlm.nih.gov/16915980/
[ix] https://pubmed.ncbi.nlm.nih.gov/19643656/
[x] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976880/
[xi] https://pubmed.ncbi.nlm.nih.gov/22296867/