Suite 17, Milford House - 7 Queen Ann St.

(off Harley St.), London, W1G 9HN






by Mr. B.M. Luklinski

MSc Medical Rehabilitation; MSc Physical Education; Dip Home Med.

Your local chiropractor or osteopath can perform a valuable service in minor cases, but he or she is unlikely to be a spinal specialist, and therefore they will not be able to solve difficult spinal cases. They tend to rely chiefly upon manipulation ('aligning' or 'popping' the spine) as a form of treatment. This is similar in effect to clicking the joints of your fingers and toes (which some people like to do from habit) and although it is effective in cases of dislocation of large joints such as the shoulder and in breaking up adhesions to provide instant relief, it is the least effective procedure for dealing with spinal problems, which can be exacerbated by this generalised form of treatment.

Mobilisation is by far the most effective procedure for treating serious spinal disorders. This achieves the aim of freeing a trapped nerve or restoring a slipped disc by gently restoring the passive mobility of the affected spinal joints through carefully applied pressure and/or oscillatory movement. The procedure as applied to the lumbar area involves a small oscillatory movement of varying amplitudes combined with some distraction (a rotation and traction movement) which is performed manually; the procedure cannot be applied using a machine. Different grades of pressure and rotatory movement can be applied. Spinal joints can be locked by the practitioner at any level while performing the procedure to focus treatment on a particular section of the spine. Mobilisation for the cervical area is similar although no distraction is included as this is applied separately if required (not by using any weights or machine) by the practitioner.

Mobilisation is a painless and essential procedure in orthopaedic medicine. It cannot cause the patient any harm and always produces good results, whereas the clunk-click approach of manipulation can often be contra-indicated by many conditions and generally should not be performed.

If mobilisation is not performed, many relatively simple cases such as sciatica cannot be treated ; but although the procedure sounds simple, there are in fact a great many medical reference books devoted to this special field of study which takes many years of clinical practice to understand. Joints are normally moved as a result of bodily movement (active mobility) but joints can also be moved by a practitioner (passive mobility) using physical procedures. A patient cannot perform these manoeuvres because it is a physical impossibility to mobilise one's own joints. They have to be moved by the application of external force which in the case of mobilisation is applied smoothly with the patient's knowledge, as opposed to manipulation, which is harsh and abrupt and not under the patient's control. So in general, mobilisation is the preferred and safest spinal treatment procedure, as opposed to manipulation.

In acute cases the patient will need to receive treatment over 4-7 sessions and in chronic cases which may have lasted for many years, the patient would normally be expected to attend for at least 12 sessions, before a back condition, such as a herniated disc, can be cured. Following treatment, mobility and strengthening exercises are given to prevent a recurrence of the problem.

Surgeons generally know nothing at all about the procedures of Orthopaedic Medicine and adopt a twin-track mentality to solving spinal problems, which amounts to 'cut it out', or 'fuse it together'. It seems to us absurd to remove a patient's disc or part of a disc in order to decompress the sciatic nerve, when this can be achieved more effectively and quite safely by mobilisation. Where stability is required, this is provided not by fusing vertebrae together, but by requiring the patient to perform certain floor-based exercises that strengthen relevant muscles. It is not a solution either to lock the spine permanently into some type of straight-jacket, as in fusion, because the body will soon start to protest!

Note: A small number of spinal conditions may not be curable if the underlying pathology is unknown. This often arises in cases of spinal deformities. However, we do not recommend surgery even in these cases (which can be made asymptomatic) because it is better "the devil you know than the devil you don't". We may only suggest surgery in extreme cases where the following mobilisation over a maximum period of three months, and allowing for a further six month period of monitoring, the patient has failed to respond or improve. This option however rarely needs to be considered.