What Physical Therapy Is

Can a Physical Therapist Perform Spinal Manipulation? How Does Manipulation Compare to an Adjustment?

Easy answer to the first part of the above question – YES! Yes, except if you live in the State of Arkansas?? (See #1 below)

Let me start by defining some words we are using:

Mobilization or manual therapy means a group of techniques comprising a continuum of skilled passive movements to the joints or related soft tissues, or both, throughout the normal physiological range of motion that are applied at varying speeds and amplitudes, without limitation.

Manipulation utilizes a high velocity, low amplitude thrust technique whereby the joint is moved beyond its normal physiological range of motion.

Adjustment “refers to a wide variety of manual and mechanical interventions that may be high or low velocity; short or long lever; high or low amplitude; with or without recoil. Procedures are usually directed at specific joints or anatomic regions. An adjustment may or may not involve the cavitation or gapping of a joint (opening of a joint within its paraphysiologic zone usually producing a characteristic audible “click” or “pop”). The common denominator for the various adjustive interventions is the concept of removing structural dysfunctions of joints and muscles that are associated with neurologic alterations. The chiropractic profession refers to this concept as a “subluxation.” This use of the word subluxation should not be confused with the term’s precise anatomic usage, which considers only the anatomical relationships.” (2)

Now, back to the topic! The manipulation technique has been added to most curriculums throughout the USA. (Interesting topic found link #3 below) The manipulation technique has been taught by most physical therapy curriculums external of the US for a long time. Some physical therapists use this technique frequently; others, not so much. Every Physical Therapist is different, but it is my opinion that a manipulation technique can be very beneficial when used with the correctly identified patient.

A question I often get from the public when discussing this topic is, “What is manipulation as compared to an adjustment that is traditionally performed by Chiropractors. Here’s the skinny:

The easy answer is that both techniques usually involve the technique culminating with an audible “pop”. The pop is referred to as a cavitation in the physical therapy world and is the result of the release of nitrogen gas within the joint. This is where the similarity between the two end. Once again, I’m not a Chiropractor so I will not speak for them. (Read link #4 and #5 to see what a Chiropractor has to say on this topic.) As for the field of Physical Therapy, the cavitation itself is not the purpose of the technique, just a byproduct of it. The primary reason why a Physical Therapist uses this technique is to create mobility in an otherwise tightened joint.