Randomized Clinical Trials show Thoracic Spinal Manipulation to be an effective treatment for Cervical Radiculopathy
If you have symptoms of pain/tingling/numbness in your shoulder/arm or hand, it is likely a result of a problem stemming from your neck commonly known as cervical radiculopathy, and it is most commonly associated with a cervical disc derangement or other space-occupying lesions, resulting in nerve root inflammation or impingement. As a result of the nerve being compressed, it can send these symptoms down the arm and into the hand. Generally speaking, the further down the arm the signs travel the worse off it is. This is called peripheralization. When pressure is relieved in the neck and upper extremity, hand symptoms may disappear or move toward the area that is producing them- the point of origin (the neck). This concept is called centralization and is a good thing. This means that you are closer to recovering from your condition.
So does something as simple as cracking your neck help?
This is a question that people have wondered for years is does cracking your neck help to relieve the pain? Recent evidence supports that it does! The use of high velocity, low-amplitude (HVLA) thrust manipulation of the thoracic spine- or upper to the mid-back area- is evidenced to increase ROM and decrease pain more than the non-thrust mobilization of the same joints. In a study published in the Journal of Orthopaedic & Sports Physical Therapy, one session of thoracic manipulation resulted in improvements in pain, a disability rating, cervical ROM, and deep neck flexor endurance in patients with cervical radiculopathy. Immediately after treatment and around the 48-to-72-hour window following the procedure, the manipulation group had at least moderate improvements in symptoms compared to the sham manipulation group. The manipulation group also had moderate to substantial changes over time.
But is it safe? Could it worsen the symptoms?
In the same study, adverse reactions were also recorded and indicated that this should not be a concern. No increases in the neck, arm, or hand symptoms were reported immediately after the treatment or at the 48-to-72-hour follow-up. Additionally, no soreness lasting more than 3 hours was reported.
The findings of this study support clinician decision to use spinal manipulation for both immediate and short-term benefits for patients with cervical radiculopathy and support that thoracic manipulation specifically, in patients with cervical radiculopathy, is an effective early treatment option.
What are the sounds you hear with “popping or cracking” joints and where are they coming from?
This has also been a hypothesized subject for quite some time. The “popping sound” phenomenology is still not fully understood. Traditionally it has been accepted that the “popping sound” is a result of gas bubble collapse, but it is unclear whether or not this is true.
When there is a “pop”- formally known as a “cavitation,” it has also been unclear exactly where the sound is coming from until now. The popping sound, or high-frequency vibration, should be expected as the desired effect of HVLA thrust manipulation provided from an external force that creates motion at the joint level. The sound is one of the main features that define an HVLA thrust manipulation.
According to a recent study titled “Unilateral and Multiple Cavitation Sounds During Lumbosacral Spinal Manipulation” practitioners performing spinal manipulation at the low back-pelvis area, or lumbosacral region (specifically L5-S1), should expect multiple popping sounds that most often occur on the upside or the downside facet articulations, but not typically both. There is, however, still question as to whether the multiple “popping sounds” found in this study emanated from the same joint or adjacent ipsilateral or contralateral facet joints. Therefore, it cannot be determined whether or not it is possible to isolate a single spinal segment during HVLA nor whether the relief felt by the patient is due to “correcting” a single-targeted joint dysfunction or multiple at once. The methods also may not necessarily be able to explain all of the audible sounds during HVLA thrust manipulation.
The study WAS able to determine that the “popping sounds” were no more likely to occur on the upside [176 ipsilateral pops] or the downside [144 contralateral] pops) during  HVLA thrust manipulations, but they were almost always unilateral with only 2% of cases resulting in “popping sounds” occurring on both sides. Further research is needed to investigate the remaining unknowns.
Who can perform this treatment for me?
At Fox Physical Therapy, all of our clinicians can perform the thoracic manipulation treatment described above. Additionally, Dr. Fox, Dr. ‘O’Rourke, Dr. Alexander, and Dr. Espinosa are all SMT-1 certified having completed additional continuing education specifically in Spinal Manipulation Therapy. Let us help you today!
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