Manual therapy of the spine. Manual therapy: what benefits does this therapeutic method bring? Can manual

Currently, there is practically no person who is not bothered by problems with the spine. This is not surprising, given the modern computer age. Some are forced to sit for hours at a computer out of duty, and some of their own free will. Where can we avoid diseases of our main core? There are a huge number of methods and methods for treating such problems. In this article we will try to figure out how it can help with osteochondrosis.

What is the basis of manual therapy?

The doctor sets himself the task of restoring motor function and restoring mobility between the vertebrae. With osteochondrosis, nerve endings are pinched and the mobility of some parts of the spine is impaired. When such a picture is observed in the cervical region.

If nothing is done, the spinal ligament sprain becomes increasingly unstable and can lead to subluxation. Manual therapy for osteochondrosis of the cervical spine aims to eliminate these problems.

The chiropractor uses several techniques:

• Mobilization relaxes the neck and shoulder girdle.
• Direct contact in the form of blows, turns, bends and straightening has great advantages in the formation of joints and vertebrae.
• Indirect contact.

During the procedure, the doctor influences various reflex zones, receptors located in muscles, tendons, and ligaments. Manual therapy for osteochondrosis of the cervical spine helps not only to relax the muscles of the neck and shoulder girdle, but also to improve blood circulation and lymphatic drainage.

How can manual therapy help?

According to statistics, almost half of office employees who are forced to sit at computers and papers all day suffer from cervical osteochondrosis, and in a rather advanced form.

This disease brings a lot of health problems, so the main task of manual therapy is as follows:

To help with manual therapy, a complex of therapeutic exercises is prescribed, which will help bring the muscular system in order.

Indications for manual therapy

Manual therapy for osteochondrosis of the cervical spine has various indications; most often it is prescribed for the following conditions:

• Pain in the thoracic spine, which radiates to the heart area, with a normal cardiogram.
• Pain in the cervical spine.
• Acute pain in the lower back.
• Chronic inflammatory processes in the lumbar region.
• Osteochondrosis.
• Scoliosis.
• Protrusion of intervertebral discs.
• Intervertebral hernia.
• Spondyloarthrosis.
• Lumbar artery syndrome.
• Vegetovascular dystonia and many others.

Only a doctor prescribes such a procedure, and it is advisable that it be carried out by a real specialist in his field, so as not to cause even greater harm to your health.

How is the session going?

First of all, when a patient comes for a session, the doctor asks him to lie down on the couch. For all manipulations to give maximum effect, you need to relax and breathe slowly and evenly.

The traumatologist uses his hands to carefully examine the condition of the spine, ligaments and muscles, as well as joints. If a specialist has extensive experience in this matter, then even without an x-ray it is not difficult for him to determine the places of greatest pressure and inflammation, but it is better to go to an appointment with a chiropractor already with the pictures.

If there are problems with the spine, then manual therapy is quite capable of helping. The photo demonstrates that in order to relax, the doctor performs a light massage at the beginning of the session.

Gradually, all movements become more noticeable, the doctor presses harder on them, turns the patient’s neck. At this time, the appearance of a crunch is considered normal. Usually after this the pain becomes noticeably weaker.

The frequency of sessions depends on many factors and is prescribed by a doctor. Usually, the procedure needs to be repeated every 3-4 days; in some cases, when the patient tolerates the influence of a chiropractor on his spine well, you can visit the office every day.

It is important to remember when going for an appointment that the sessions can be quite painful, especially at the very beginning. Usually this phenomenon is short-term, but if the pain is severe and difficult to bear, you should tell your doctor.

To increase the effectiveness of manual therapy, physiological procedures are often prescribed simultaneously with it. Together, these treatment methods give good results.

Patient behavior after the procedure

After the session, the patient should not immediately jump up and run home. The body needs rest, and the spine can be immobilized using a special corset.

All head tilts, sudden movements and turns in the cervical region should be excluded. After the session, in some cases, there may be some increased pain caused by the impact on the tissue. To relieve it, you can take a painkiller.

Contraindications to the use of this treatment method

Despite the great benefits, manual therapy for osteochondrosis of the cervical spine has the following contraindications:

1. Senile age.
2. The presence of a tumor in the brain or spinal cord.
3. Inflammatory processes of a nonspecific nature in the spine, for example, tuberculous spondylitis, rheumatism.
4. Meningitis, encephalitis.
5. After surgery on the spine.
6. If there are fragments of hernias.
7. Presence of acute infection.
8. High blood pressure.
9. Exacerbation of chronic diseases such as hepatitis, pancreatitis, cholecystitis.
10. Recent heart attack or stroke.
11. Vascular diseases.

There are also relative contraindications, in which the use of manual therapy for osteochondrosis of the cervical spine is decided in each case individually.

These include:

• Exacerbation of cervical osteochondrosis.
• Instability of some parts of the spine.
• Anomalies of the spinal column, for example, spinal cleft, sacralization.
• Forstier's syndrome.
• 2nd and 3rd trimester of pregnancy.
• Fusion fractures of the spine.

A real specialist will never conduct a session if there are at least some contraindications.

Complications after the procedure

If you do not conduct a thorough diagnosis before going to a chiropractor, you can get various complications after the procedure, the most common may be the following:

• Hypermobility of the spine as a result of abnormally mobile ligaments.
• Spinal fracture.
• Ligament rupture.
• Bleeding.

If you have no contraindications to the session, but during it you feel severe pain, discomfort, and after all the manipulations your whole body hurts and you cannot get up, then you must refuse the services of this doctor or discuss all your unpleasant sensations with him. This is the only way you can avoid many complications.

According to the survey, 15% experienced dizziness after the procedure, 5% experienced increased mobility of the spine, 22% experienced increased pain, and 7% experienced progression of the disease. These are the side effects that manual therapy can have for osteochondrosis of the cervical spine. It is imperative to weigh the pros and cons before embarking on such a procedure.

The dangers of manual therapy

Analyzing all the complications and undesirable consequences of manual therapy, we can conclude that this is not a panacea for all diseases, but rather a roulette. Anyone who is lucky enough to find an excellent specialist and undergo all the procedures for the benefit of the body will be one step closer to their recovery.

Currently, even in medical circles there is no clear answer about the benefits and harms of such treatment. The danger of manual therapy for osteochondrosis of the cervical spine is also fraught with the fact that there are a lot of private clinics and medical centers, but this is not a guarantee that they employ real professionals.

If you have back pain, you should not rush to such doctors; it is better to undergo a full diagnosis and find out the cause of the pain, and then begin treatment. A true expert in his field will already be able to determine the location of pathological processes with his hands and choose the most appropriate methods for eliminating them. But an amateur in this matter, even with minor problems, can do more harm to the body and aggravate the situation.

How to choose a doctor?

A chiropractor is a doctor like any other. This specialization involves an in-depth study of neurology, diagnostics and other areas of manual therapy.

When choosing a doctor, you need to make sure that he has qualifications confirmed by a certificate and can use manual techniques. Considering that educational institutions began training such specialists no more than 10 years ago, we can conclude that their number is not so large, so running into a charlatan is quite possible. Manual therapy for osteochondrosis of the cervical spine has positive reviews only if a real professional deals with the spine.

When visiting such doctors, patients are completely satisfied with the result and can confidently recommend them to their friends and relatives.

Prevention of osteochondrosis

There is no need for manual therapy for osteochondrosis of the cervical spine if you prevent this disease. It includes the following activities:

1. Physical activity.
2. Performing special exercises to strengthen the neck muscles.
3. A diet with sufficient vitamins, minerals and proteins.
4. To give up smoking.
5. Periodic self-massage of the neck.
6. Sleep on an orthopedic mattress and pillow.
7. Regular medical examinations.

If you adhere to these simple rules, then no osteochondrosis will be scary.

The history of manual therapy dates back perhaps thousands of years, since this medical practice has been known since time immemorial.

At the moment, experts do not deny the effectiveness of the technique in relation to various diseases of the spinal column, therefore they quite often include it in treatment regimens for ailments associated with degenerative changes, disruption of the normal anatomical position of the vertebrae, prolapse of intervertebral hernias, and the like.

Experts recognize the effectiveness of manual therapy

This interest in this type of treatment is explained by the fact that manual therapy of the spine has the highest percentage of complete recovery. At the same time, the method is a frequent cause of complications. What is manual therapy? What are the pros and cons of manual therapy today?

Using the technique of manual manipulation of the spine, in just a few sessions you can get rid of persistent pain in the back, discomfort in the spine when performing movements, pain due to diseases of the joints of degenerative origin, and much more.

Manual therapy effectively relieves back pain

According to numerous reviews of manual therapy, this method allows you to eliminate functional blockages of nerve fibers caused by displacement of the vertebrae, relieve spasm from the muscle tissue of the back, restore normal blood supply to the affected areas of the spine, and the like.

What kind of treatment is this?

What is manual therapy: the benefits and harms of the technique? What is the essence of manual influence on the body? Similar questions concern many patients who are faced with the need to try this treatment method on themselves.

“Manual” or manual treatment is a set of therapeutic techniques based on techniques of manual influence on the structural elements of the musculoskeletal system, which makes it possible to identify and treat a huge number of pathological conditions in this area.

The main advantage of such a correction is that it is natural and safe compared to other similar methods, for example, massage.

If we consider how massage differs from manual therapy, the key argument here is the wider range of effects on the spine and the effectiveness of manual treatment compared to other options for similar treatment. In addition, in recent years the technique has been widely used in pediatrics. Manual therapy for children (including manual therapy for infants) is successfully used in treatment regimens for childhood spinal diseases, asthma, as rehabilitation and elimination of the consequences of injuries.

You will learn more about the manual therapy method from the video:

Vertebrologists often practice manual therapy during pregnancy, when, as a result of increased loads on the spinal column, a woman begins to experience back pain associated with weakening of the muscles and ligaments of the back, as well as old mechanical damage.

Sometimes doctors have to combine two issues such as manual therapy and HIV infection.

Manual therapy is most often prescribed for. It is in this segment that severe pain occurs, which is accompanied by nausea, dizziness, fainting, and the like. Manual therapy for cervical osteochondrosis is a real chance to overcome chronic pain in the neck.

Manual therapy for low back pain is a common practice for many diseases of this segment of the spinal column. The most common option is manual therapy, the effectiveness of which is about 65%.

So, there are the following indications for manual therapy:

Main types of manual treatment

Varieties of manual practice are divided into several classes, based on the direction of influence and depending on therapeutic goals:

• manipulative influence(treatment of diseases of the spine, ribs, pelvic bones, limbs);
• visceral manual therapy, which deals with the treatment of internal organs (similar manual therapy of internal organs is used in relation to patients suffering from pathologies of the intestines, heart, lungs, and pelvic organs);
• craniocervical manual therapy, aimed at correcting headaches and problems with the bones of the skull (manual therapy for headaches is a common method of preventing cranialgic attacks, the main cause of which lies in the obstruction of the patency of the cervical vessels);
• self-medication or manual therapy to oneself, when the patient independently performs manual manipulations;
• myofascial manual therapy techniques, the action of which is aimed at strengthening muscles and ligaments, relieving muscle spasms, etc.;
• complex of manual therapy methods for joint pathology;
• gentle manual therapy or kinesiology, the therapeutic effect of which occurs as a result of a complex effect on three components of human health: the musculoskeletal system, metabolic processes and emotional background.

It is difficult to find a doctor who is fluent in absolutely all manual techniques.

But we can confidently say that a specialist who has thoroughly studied at least one option of manual influence will definitely help the patient cope with the problem that worries him.

Rules for the procedure

Before visiting a specialist for the first time, many patients are interested in how long a manual therapy session lasts. On average, the procedure takes about 30 minutes. This time is absolutely enough to carry out all the necessary manipulations to correct the pathological condition. The therapeutic effect should appear after 1-2 sessions. Therefore, when asking the question how many manual therapy sessions should be done, an experienced specialist will answer - about 7-10, but no more than 15 per year.

Watch the video to see how a manual therapy session goes:

How often can spinal manual therapy be done?

Doctors recommend not to rush to complete the full course of manual treatment and maintain reasonable pauses between sessions, which are about 2-6 days, depending on the severity of the pathological process, individual characteristics and age of the patient.

Contraindications to the technique

Despite the fact that manual therapy methods are effective in relation to a huge number of musculoskeletal diseases, this treatment option has its contraindications for use:

• malignant tumors of the spinal column, skin and visceral organs;
• inflammatory processes of the spine in the active phase;
• vertebrae;
• some congenital pathologies of the musculoskeletal system and genetic developmental defects associated with increased bone fragility;
• conditions after surgical interventions;
• acute pathological conditions of the spinal cord;
• diseases of the digestive tract in the acute phase;
• open form of tuberculosis.

A negative effect from manual therapy can also occur after a manual therapy session for a patient who has relative contraindications, for example, old injuries. The doctor must take into account such contraindications to manual therapy when prescribing a course of treatment, which will avoid the occurrence of undesirable consequences and complications of the underlying pathological process.

If the doctor does not take into account contraindications for manual therapy, serious complications may occur.

Possible consequences

In most clinical cases, the sensations after manual therapy are always positive, and a person can say with confidence that this technique has allowed him to improve his health. But sometimes it happens that after a manual therapy session your back hurts, you feel dizzy, or your overall body temperature rises. Why is this happening? What are these symptoms associated with?

As you know, each body is individual, and therefore reacts completely differently to treatment.

Often, the consequences of manual therapy make themselves felt after the first session of manual manipulation, and patients begin to complain about the appearance of unpleasant sensations, which they associate with the side effects of the treatment.

Sometimes people complain that they feel dizzy after chiropractic treatment. A similar reaction occurs in approximately 1 in 1000 patients who have used the services of a chiropractor. This side effect is temporary and most likely associated with blood redistribution. Therefore, if you experience a headache or dizziness after manual therapy, you should seek clarification from a specialist.

Fever after manual therapy is an extremely rare symptom. It appears predominantly in patients suffering from chronic inflammatory processes, which are activated and aggravated by manual influence. In any case, if after manual therapy you feel worse and your general health has deteriorated, you should visit a doctor as soon as possible to clarify the nature of the ailment.

Manual therapy is a method of healing using the hands; a technique with which a specialist influences various parts of the spine, muscles, joints and ligaments to eliminate spasms, displacements and functional blocks. It is used in the treatment of the musculoskeletal system, which not only effectively restores back health, but also stimulates blood circulation, strengthens muscles and joints, and gives them tone.

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Main characteristics

The method of manual therapy is that first the functional blockade is removed from the spinal column, after which symptomatic treatment is applied using relaxation manipulations.

Manual massage is the basis of intensive massage, and in order to obtain a positive result, a full course of treatment is required.

Mechanism of action

Manual therapy is an effective treatment for many diseases. There are 3 directions of influence on the body:

• Peripheral. The action occurs at the level of soft tissues, ensures rapid recovery, accelerates blood circulation, and normalizes the circulation of physiological fluid.
• Neurophysiological. The conductivity of nerve impulses is normalized.
• Psychophysiological. It affects not only the damaged area directly, but also the overall condition of the body.

During a course of procedures, a change in muscle tone is observed, self-regulation processes improve, the feeling of one’s own body changes, behavioral reactions change and mood improves.



Methods

The manual therapist (the therapist who performs the manual massage procedure) chooses a specific technique depending on the patient’s clinical picture. There are several methods of therapy, the main ones are the following:

• Arthro-vertebral method. Treats sore joints using traction push (intensive massage). The technique helps restore the functioning of the spinal disc apparatus and copes with pathological processes in nerve endings.
• Myofascial technique. Used in the treatment of extensive pathologies of the vascular system, pain in the joints, and neurological diseases. Promotes the resumption of muscle and fascia reflexes.
• Visceral therapy. It can be the main method of treatment, without the use of medications. Used in the treatment of internal organs, for example, lungs, intestines, spleen, kidneys, reproductive system and others.
• Cranial method. Prescribed for diseases of the brain, affects the joints of the skull and neck muscles. Helps with frequent weakness, decreased concentration, memory loss, sudden attacks of headaches and impaired intracranial pressure.



Techniques

In medical practice, various techniques are used to carry out one or another manual procedure. The choice is purely individual, depending on the patient’s clinical opinion; in addition, therapy is carried out at intervals of 1 to 3 days, session time is from 15-30 minutes, no more than 15 procedures per year. The main techniques are the following:

• Push mobilization. The specialist performs various manipulations directly on the affected joints. During the session, the doctor realigns displaced intervertebral discs and removes subluxations of articular structures.
• Rhythmic mobilization. There are three types of procedures that imply a clearly defined method of influence. The stretching technique is intended for the surface of the joints, the rotating technique affects the connecting structures, and the compressive technique is used when it is impossible to use the above methods.
• Positional mobilization. A technique that involves gradual stretching of the joints, resulting in the restoration of functional reserve and the elimination of any complications in the treatment of the musculoskeletal system.
• Postisometric relaxation. A procedure for intense and gentle stretching of muscles, as a result of which pain in the lumbar, thoracic, cervical and other parts of the spinal column disappears.

Diagnostics

In order to correctly make a diagnosis, it is necessary to undergo an examination that will show the clinical picture of the patient. To begin with, the doctor conducts a survey, after which a number of diagnostic procedures are prescribed:

• urine and blood analysis;
• radiography;
• Magnetic resonance imaging;
• CT scan;

Based on the diagnostic results, they may also prescribe an ultrasound of the blood vessels of the brain, thyroid gland and pelvic organs.

Indications for therapy

Manual procedures are prescribed for the complex treatment of various diseases, as well as for long-term drug therapy, which does not produce positive results.

The following indications for use exist:

1. 1. Intervertebral hernia.
2. 2. Osteochondrosis.
3. 3. Scoliosis.
4. 4. Torticollis.
5. 5. Flat feet.
6. 6. Pseudoangina.
7. 7. Thoracalgia.
8. 8. Cervicalgia and others.

For osteochondrosis

The spine is a major organ that consists of ligaments, muscles, blood vessels and nerves, which is why it is important to monitor its health.

Manual procedures for the treatment of osteochondrosis include a number of methods and techniques, which consist of the following components:

• massage;
• mobilization;
• immobilization;
• manipulation;
• functionality correction.

At the initial stage of the disease, this therapy will restore mobility and activity of the musculoskeletal system.

For the treatment of hernia

Before the session, a computed tomography scan should be performed, which will show the location where the hernia has formed. At the initial stage of the disease, the specialist uses traction mobilization, post-isometric muscle relaxation and traction (manual or mechanical).

One of the most effective non-drug practices for treating the body is manual therapy. This practice includes a whole system of specific techniques.

The main feature of the therapy is that the specialist, through simple manipulations, has a beneficial effect on the spine and joints.

general information

Manual therapy procedures are in many ways similar to massage manipulations. The main difference is that the specialist affects only a certain area of ​​the body. There are some differences in dosage, as well as in the strength of the effect.

Using this method, you can get rid of the symptoms of diseases of the muscle and bone system.

Features of therapy

The effectiveness of this method increases if you alternate it with herbal medicine, physiotherapy and reflexology. The main thing that specialists in the field of manual therapy have to work with is the spine.

Cervical spine treatment

The main methods of this type of treatment for osteochondrosis of the cervical spine include:

1. Segmental massage manipulations that help quickly warm up the muscles and remove tension from them.
2. Mobilization intended to resuscitate damaged joint functions.
3. Manipulations that involve resuscitation of the functioning of all joints in full.

The most unpleasant procedure is manipulation. It is accompanied by specific crunching sounds that make patients feel anxious.

The main contraindications include the presence of a benign or malignant tumor, as well as the course of the inflammatory process.

It is strictly not recommended for persons with chronic infectious pathology to go to a chiropractor’s office. You should not expose your body to the hands of a specialist or someone who is intoxicated.

Expectant mothers and people with recent injuries to the joints or spine should also temporarily refuse the services of a chiropractor. Otherwise, the patient's condition may only worsen.

Hernia treatment

A person who has some degenerative changes in muscle tissue often develops a vertebral hernia. It can also be effectively treated through manual therapy. But this type of treatment is not always prescribed.

The main contraindications include:

• exacerbation of the disease;
• the presence of a malignant tumor;
• spinal injury;
• pregnancy more than 4 months;
• passing of a hypertensive crisis.

The main goal of treatment for a hernia of the lumbar spine should be considered to be the impact on certain points of the body. This way the muscle system and nerve endings are activated. Against this background, a person’s posture becomes more correct. The risk of hernias is also reduced.

Another goal of this treatment should be pain relief. Even if the pain is quite severe, under the influence of the hands of a skilled specialist it will certainly recede.

In addition, treatment involves resuscitating the metabolism of the damaged element, relieving inflammation and relieving muscle spasms in the affected area.

Treatment of scoliosis

For the treatment of scoliotic disease, gentle manual therapy, developed by Dr. K. Levit, is most often used. This technique involves a gentle combination of therapeutic exercises and massage manipulations. In this case, the effect is on 1-2 vertebrae in 1 procedure. The main feature of soft therapy is gradualism and planning.

Manual therapy for scoliosis involves correction of deformities through relaxing and guiding manipulations. In this way, the functionality of the spine is restored.

The 100% effectiveness of this therapy for scoliosis has not yet been proven. This type of treatment is not always prescribed for scoliotic disease. Doctors call traumatic scoliosis the main contraindication. It is also not recommended to attend manual therapy sessions if:

• presence of spinal infections;
• the presence of various neoplasms in the actual zone;
• severe osteoporosis.

Correcting spinal curvatures in young children using this method is categorically not recommended.

Help with gonarthrosis

Doctors identify several methods of manual intervention for gonarthrosis of the knee joint. The main methods include: Russian, Eastern, Swedish, Finnish.

• In the first case, the specialist resorts to stroking and gentle rubbing. Efficiency is ensured by combining this method with physical therapy exercises and hydrotherapy.
• The main goal of the eastern method is to resuscitate adequate blood circulation. Another priority should be considered the relief of stagnation that has formed in the circulatory and muscular systems.
• Today the Swedish method is recognized as the best method of manual manipulation. Its secret lies in the fact that the specialist combines delicate rubbing with joint movements. During manipulation, the patient's muscles and joints are stretched. Rubbing of the formed tissue compactions also occurs. This helps relax nerve fibers and reduce pain. The Finnish method is in many ways identical to the Swedish one.

The main advantage of manual therapy for this disease is that the specialist affects the patient’s entire body. This contributes to the fact that the human body’s own reserves fight the disease.

How is it different from osteopathy?

Many people are interested in what the difference is between manual therapy and osteopathy. The main difference is the approach to treatment. A chiropractor works on the symptoms of a pathological condition. A specialist in the field of osteopathy uses an integrated approach. In this case, the doctor discovers and eliminates the root cause of the disease.

The main disadvantage of manual therapy is that some time after treatment, pain may reappear. With osteopathy this will never happen.

Another advantage of osteopathy is that it has a softer, more gentle effect on the human body. This allows patients of all ages to resort to osteopathy.

Also, an osteopathic specialist is able to diagnose not only the musculoskeletal system, but also the entire body as a whole. This helps achieve an amazing effect.

Possible complications

If the specialist is not careful, his actions can cause ligament or muscle rupture. Also, due to careless actions of the chiropractor, blood circulation may be impaired.

To conduct manual therapy.

The problem of contraindications to manual treatment is to some extent artificial. Obviously, in addition to the patient’s condition, expanding or narrowing the list of contraindications directly depends on the qualifications of the doctor, the correct selection of the methods used and the appropriate diagnostic capabilities of the attending physician. Treatment should always be carried out taking into account the physical or mental condition of the patient. Currently, with the development of “soft tissue” manual therapy techniques, the number of absolute contraindications may be reduced to two<в первоисточнике до "трех" [см. ссылку выше]>: patient's mental state And local tissue destruction. Potentially traumatic methods of influencing moving elements can be replaced with potentially less traumatic ones, for example, post-isometric relaxation, functional techniques, lymphatic drainage techniques, work on associated parts of the body, etc. Currently, each doctor himself must decide which methods of manual therapy and for which conditions he can use, guided by his experience, knowledge and qualifications, as well as deontological and ethical principles. However, you should always remember that if a chiropractor underestimates the severity of his patient’s condition and does not identify existing contraindications in a timely manner, then performing manual therapy can cause great harm to the patient.

An absolute contraindication is the absence of any diagnosis., even any reasonable plausible working hypothesis. There is too much temptation to treat without a treatment plan, and therefore without a possible sequence of techniques. The patient's body is so ready to gratefully accept manual therapy treatment that there is a temptation to perform it immediately and only then diagnose it. For the most part, the results are also good, until an undiagnosed pathology or congenital anatomical defect occurs. Diagnostics is an absolute prerequisite for each therapy, and its absence is a major contraindication.

Often doctors are faced with situations in which there are no direct or obvious contraindications, but an experienced doctor intuitively feels that such a patient should not be treated. The doctor should always listen to this opinion of his intuition.

Contraindications to manual therapy(recommendations from the Center for Manual Therapy of the Russian Ministry of Health).

Absolute: Tumors, infectious and acute and subacute inflammatory processes in the joints, spine, brain and spinal cord. Fresh injuries of the spine and joints, fresh fractures up to 6 months ago, condition after fresh surgical interventions on the spine, fragments of a sequestered disc herniation, focal spinal symptoms, spondylolysis, severe spondylolisthesis, grade 3 - 4 osteoporosis, Klippel-Feil disease, acute disorders of the brain and cardiac circulation, history of heart attack, acute diseases of internal organs, mental illness.

Relative: Severe developmental anomalies (nonfusion of the vertebral arches, assimilation, anomalies of tropism, sacralization, lumbarization, concrescence). Tuberculosis of the vertebral bodies. Cervical ribs III - IV degree. Fixing Forestier hyperostosis. Pathological tortuosity of the carotid and vertebral arteries. Anomalies of the head joints<примечание laesus de liro: сустав "затылочная кость - позвонок СI" и "сустав Крювелье: СI - СII">. Saddle hyperplasia of the atlas. Arnold-Chiari malformation II - III degree. Severe somatic diseases.

This list of pathologies is significantly narrowed in comparison with the previously proposed contraindications described in the specialized literature and, of course, does not cover the entire range of difficulties that a chiropractor may encounter.

Sitel A.B. describes some differential diagnostic signs that should alert the doctor regarding neoplasms: 1 . Discrepancy between subjective and objective clinical symptoms; 2 . The presence of a vegetalgic component that cannot be controlled by medication and physical methods; 3 . In the presence of a vegetalgic component, the irradiation of pain, sensitivity disorders, and paresis of the lower extremities is bilateral; 4 . Combination of a pronounced vegetalgic component with paresis of the proximal or distal parts of the lower limb.

Difficulties and complications of manual therapy.

Any type of medical care (therapy, surgery, etc.) can lead to an objective or subjective deterioration of the condition. This is especially true for such an individual treatment method as manual therapy, especially if the capabilities of manual therapy are overestimated and there are unjustified expectations of healing in all cases. The reasons for such deterioration may be both incorrect diagnostic or therapeutic influence of the doctor, and inadequate perception of such influence by the patient. A doctor performing certain therapeutic and diagnostic procedures must be prepared for such complications. Even the most qualified chiropractor has examples of unsuccessful treatment. The most “offensive” examples of such treatment arise in the case of inappropriate behavior of the patient in response to even the most correct treatment. It is extremely difficult during the initial examination to identify the imbalance and inadequacy of the patient’s behavior, before which the doctor remains completely unprotected. It is the troublesome and scandalous nature of such cases that is an obstacle to the widespread dissemination of the method of manual therapy in large medical institutions in the territory of the former Soviet Union, where there is insufficiently regulated legislation on the relationship between the patient and medical institutions, and explains the tendency towards gentle and strictly documented implementation of techniques by Western specialists.

When discussing the possibility of complications after manipulation, especially in the cervical spine, the possibility of serious damage as a result of this treatment method is constantly emphasized. Although you need to imagine that if you compare the number of manipulations performed daily with the mortality rate, then the danger is extremely small. With careful use and continuous monitoring of the patient's symptoms and manifestations, the risk of serious damage becomes almost impossible, especially considering that manual therapy is not used by competent doctors in patients with serious pathologies. However, the doctor must carefully weigh the risk of not only a possible complication, but also carefully weigh the consequences of such a complication, both for the patient and for himself.

In addition to the underlying disease, any patient may also have a mechanical disorder of the movement apparatus. As long as the purpose of the technique is to eliminate a mechanical disorder and it is performed with sufficient caution, many contraindications can be considered relative. The main reason for dividing manual therapy techniques into different categories and modalities in a variety of modifications is to avoid the need to use potentially dangerous techniques, for example, on an elderly patient. In such cases, the use of soft techniques is acceptable. Therefore, in the case of relative contraindications, it would be more accurate to talk about the problem of the correct choice of manual technique. Thus, in conditions that absolutely do not allow for rotation with counter-holding, one can find techniques that alleviate the patient’s suffering, for example, light traction, post-isometric relaxation, etc. Manual therapy should always adapt to the structure of the body, taking into account age and tissue condition, which is determined during a general preliminary examination.

For example, bladder and bowel dysfunction or loss of sensation in the perineum will also be signs indicating a contraindication. Signs of spinal cord damage are also contraindications to any form of active manipulation. Performing a very gentle mobilization would be a fairly safe method, but it is unlikely to be of much use. Traction techniques will also be quite safe and, although they are used from time to time, it is quite difficult to see their positive effect on the change in spinal symptoms, but if the use of these techniques does not bring success, then it is not worth taking active measures.

Iatrogenic complications mainly occur due to inaccurate examination, assessment of the pathological process and the use of inadequate techniques in a particular situation. Under-examination of the patient leads to incorrect diagnosis, which in turn leads to incorrect treatment. Some chiropractors often do not have the diagnostic skills necessary to prescribe manipulation. It must be remembered that the patient’s coming to the doctor does not necessarily mean that manual therapy should be performed. First of all, the arrival of a patient means determining the indications for manual therapy in general and establishing a preliminary diagnosis, which must be confirmed by various diagnostic methods, including hardware ones, such as radiographic, ultrasound, laboratory, etc. This assessment is completed both before the first session and before each session.

Another possible cause of complications- lack of skill as a doctor. A physician with excellent diagnostic ability to identify and treat the affected segment, but with insufficient general clinical and general diagnostic training, is as great a threat to safe manual therapy as unskilled manipulators. At the same time, many cases of complications, including fatal ones, were described, when the lack of skill and experience was replaced by brute force.

Applying manipulation without any formal training is probably one of the biggest challenges of manual therapy.. Reading a textbook or attending short introductory courses does not make even a good doctor a chiropractor. The absence of at least some controlled skills in performing a technique should be a contraindication for treatment. According to Ivanichev G.A. the set of standard treatment techniques available to an amateur and applied to any clinical situation is doomed to complications, sometimes very serious.

The third cause of iatrogenic complications is insufficient interprofessional consultation. If the doctor does not sufficiently know the diagnostic criteria for establishing contraindications for treatment or wants to “insure himself” in the event of a possible complication, if there is the slightest doubt about the diagnosis, it is better to consult a related specialist. Self-confidence caused by high qualifications in the field of manual therapy, to the detriment of general clinical training, sooner or later leads to complications due to a “missed” disease or due to an undiagnosed congenital pathology. In order to know that treatment, for example, while taking steroids or blood thinners, can lead to complications, you need to know that there are side effects from taking these drugs in the form of osteoporosis or bleeding. In order to prevent complications from performing manual therapy against the background of a particular disease, you must at least know that such a disease exists at all, and also know the clinical manifestations, general diagnostics, or what specialty doctor can confirm or refute the diagnosis of such a disease. Below is an analysis of some possible complications, which, however, do not cover the entire range of possible difficulties that arise during treatment.

Excessive, insufficient or technically inadequate treatment. At certain stages of the disease (for example, exacerbation of spinal osteochondrosis), changes in the motor stereotype are adaptive, compensatory in nature. Under these conditions, thoughtless – “from the coccyx to the back of the head” elimination of functional “blockades” without appropriate manual diagnostics will only delay the rate of recovery. Carrying out manipulation in unaffected motor segments of the biokinematic chain contributes to the emergence of new dysfunctional lesions, as well as the removal of protective myofixation, which leads to a pathological motor stereotype, hypermobility and relapses of blocking. Violation of technical execution or tactical application of techniques can lead to both traumatic injury and insufficient effectiveness of therapeutic measures. Excessive force when performing techniques can lead to traumatic complications, and insufficient force can lead to a lack of effect. It should be noted that forced or excessive efforts to overcome pain reactions at the time of performing techniques are the most common mistakes when performing manipulative treatment.

Acute period. Direct influence in the acute period is not always desirable, since in these cases additional damage to the ligaments, displacement of the moving parts of the joint, an increase in circulatory disorders in the form of increased congestion, etc. are possible, inevitable during manual therapy. In addition, in such cases, local sanogenetic rigidities are usually mobilized. However, treatment of associated motor segments, the so-called, can have a good effect. key areas of the spine, visceral and cranial manual therapy.

Disc offset. Complications that arise during manipulation or mobilization of the spine include severe neurological disorders caused by sequestration of a disc herniation and displacement of the nucleus pulposus into the spinal canal with the development of compression and vascular complications (paralysis, myeloischemic changes, central hemodynamic disorders after treatment in the neck, etc. .). Such manifestations quite often can be directly related to treatment in the area of ​​an existing disc herniation due to an increase in its size. Therefore, the worsening dynamics of symptoms should always be noted and the possibility of sudden decompensation due to an increase in the size of the hernia should always be taken into account, especially with rotational techniques of manual therapy.

Instability and spondylolisthesis. Intensification or appearance of instability, or even spondylolisthesis, after manual therapy, especially with frequent repetition of manipulations on one segment or with incorrect technical execution of the technique with the absence of pretension and exposure of adjacent segments using occlusion (in this case, manipulation on the blocked segment occurs successfully, but traumatic blocking of adjacent segments). It should be noted once again that manual therapy is aimed at increasing the range of mobility, primarily of hypomobile structures. Incorrectly performed specific manipulation or nonspecific manipulation without an accurate diagnosis of range of motion can lead to pathological hypermobility. An increase in pathological mobility leads to increased disc protrusion and compression of neurovascular formations by bone structures of hypermobile moving elements. Such artificially induced hypermobility is subsequently extremely difficult to treat. !!! --> Displacement of a vertebra by more than one third of the vertebral body is a contraindication for manual therapy, since in this case the pathological mobility in the motor segment of the spine sharply increases and the possibility of compression of the spinal cord. The diagnosis of spondlolisthesis is valid only after functional radiography. In case of spondylolisthesis or instability, an effect that increases the range of motion is certainly contraindicated due to the aggravation of the patient's condition, but this does not prevent the impact from being carried out at adjacent hypomobile levels, of course, when using techniques that do not cause movement at the level of spondylolisthesis.

Spondylosis, assimilation, concrescence, etc.. Manual therapy of excessive stiffness created by spondylosis, fixation ligamentosis, concretion, and spondylosis can result in damage to or fracture of the ossified ligaments with subsequent instability and disability, especially after manual therapy in the cervical spine. Such rigidities are relative contraindications in the absence of narrowness of the spinal canal caused by such lesions due to their compensatory-adaptive nature. To alleviate the patient's complaints, work is used on related areas of the body. Directly at the site of the lesion, only treatment of the soft tissues located above the lesion can be used without the use of stretching methods (good results can be obtained by using functional techniques, in particular the “local listening” technique).

Complications of soft tissue techniques. Complications can occur not only when performing manipulative treatment, but also when treating with soft tissue techniques. For example, with a forced stretching force of the fascia, which is stretched in this case not in the place of greatest compaction, but at the junction of the transition between the normal and shortened section (i.e., in the place of least resistance), stretching of an overstretched ligament (which can also cause pain) or excessive and frequent stretching of shortened ligaments with further relaxation of the ligamentous apparatus and iatrogenic hypermobility, increasing the pace of rhythmic execution of the technique, which, on the contrary, leads to an even greater reflex shortening of the myofascio-ligamentous structures, etc.

Marginal growths (osteophytes). Caution is necessary in the presence of marginal bone growths on the posterior and posterolateral surfaces of the vertebral bodies, especially in the cervical spine, against the background of existing instability, as well as against the background of narrowing of the spinal canal due to possible injury to the surrounding neurovascular structures. !!! --> Some authors indicate that manual therapy is contraindicated, even if the radiograph reveals only marginal bone growths and there is no instability in the segmental area. According to Sitela A.B, osteophytes in the cervical spine, directed posteriorly, can injure the root in the intervertebral foramen, and in the lateral direction - the vertebral artery. It was found that the presence of osteophytes with a length of more than 1.5 mm in the lateral direction in the cervical spine can cause compression and even rupture of the vertebral artery during manual diagnostics and therapy. Even if you try to perform them with such an osteophyte, a deterioration in the condition may occur in the form of dizziness, headache, nystagmus, the appearance or increase of numbness in the hands, back of the head, and face. If the vertebral artery is damaged in such cases, the functional stage of vertebral artery syndrome may turn into an organic one. At the lumbar level, osteophytes are less important, since the root is more often threatened by disc protrusion itself or its loss. There is a possibility of an osteophyte fracture either as a result of household overexertion or injury, or as a result of rough manipulation performed by a doctor.

Osteoporosis, fractures. Vertebral fractures occur as a result of manual therapy for osteochondrosis in patients with systemic or local osteoporosis of the spinal column of various etiologies, for example, against the background of cancer or hormonal spondylodystrophy, etc. Osteoporosis becomes apparent on radiographs when approximately 40% of the bone structure is lost. When performing manipulations on the spine, fractures of pathologically altered vertebrae are possible. It is not uncommon for bone fractures to occur simply due to rough execution of the technique. !!! --> At the same time, treatment without prior x-ray examination may lead to mobilization or manipulation treatment at the site of the pathological fracture. This cause of pain may well occur in older women or after traumatic falls.

Vascular disorders. Complications can occur with difficult-to-diagnose anomalies of the vascular system in the vertebrobasilar system, the Adamkiewicz and Deproge-Gotteron artery system, or with their injury during treatment, especially with incorrect manipulation. To prevent such complications, it is always necessary to perform tests to establish a minimal deficit of blood flow in the vertebral vascular system or rotation tests to establish a disorder of spinal blood flow, the mechanism of their occurrence and the subsequent choice of treatment. It should be taken into account that therapeutic techniques should not imitate postures when performing provocative tests that reveal blood flow deficiency.

Chondrogenesis disorders. Congenital disorders of chondrogenesis of the spine and large joints exclude a forced increase in mobility. Only indirect and soft tissue techniques are acceptable.

Complications associated with the selection of patients for treatment without taking into account somatic pathology and general clinical manifestations. You should always remember about diseases of the internal organs, which can cause viscerovertebral syndromes in the form of blocking the motion segment. In this case, treatment, especially manipulative treatment, can lead to trauma to the structures of the motor segment, exacerbation of a somatic disease, or, more often, to a relapse of blocking. Excessive re-treatment in this case is guaranteed to lead to hypermobility. Of particular importance in such cases is the pathology of the central and peripheral nervous system, as well as the anatomical and constitutional features of the musculoskeletal system as a whole. As a rule, such complications arise as a result of an insufficiently complete and thorough examination, but, what is even more annoying, often as a result of increased self-esteem of both the doctor himself and the treatment methods he uses. !!! --> You should not rush to perform manual therapy for cardialgia; in such cases, preliminary electrocardiography is necessary. Carrying out manual therapy against the background of severe coronary heart disease or heart attack can lead to irreversible consequences and even death. Techniques with potential tissue trauma such as manipulation or ischemic compression (acupressure) should not be performed in case of changes in the blood coagulation system (increase or decrease), diseases of the lungs and blood vessels, as this can cause vascular thrombosis and corresponding severe complications. Manipulations in patients receiving treatment with anticoagulants (danger of hemorrhages), steroid drugs (danger of bone loss, osteoporosis), muscle relaxants (inability to form protective myofixation after treatment and restore impaired postural and motor balance), etc. – are used with extreme caution and low-injury. If the patient is prone to high blood pressure, heart attacks, arrhythmias, after recent operations, with artificial joints, etc. A gradual increase in the degree of mobilization as well as its duration is required to allow the patient to familiarize and adjust to the unusual sensation and physiological changes, thereby reducing some of the risk of treatment. There are quite a lot of similar “traps” among the patient’s “ordinary” diseases.

Pregnancy. It is believed that pregnancy beyond 12 weeks is a contraindication for manual therapy. However, according to Maitland G.D., 1970, pregnancy creates mechanical and technical difficulties, but there are no absolute obstacles to manipulation. Such a statement may be true, however!!! --> even an accidental coincidence or straining of the patient, which may cause the water to break or stimulate the uterus, leads to absolute discredit of both the chiropractor and the entire method as a whole. Such treatment can only be performed in a specialized treatment department.

Age . Age itself is not a contraindication to manual therapy. However, extreme age limits require both increased caution when performing techniques and a thorough assessment of the patient's condition before treatment. Accordingly, the treatment of senile tissues that are compacted and affected by the degenerative-dystrophic process does not tolerate harsh treatment that can lead to their injury (rupture, fracture, etc.), in addition, concomitant therapeutic pathology (cerebrovascular accident, hypertension, damage to the cardiovascular systems, etc.) significantly complicates treatment. According to Sitela A.B., with age, patients gradually increase tonic tension of the scalene muscles, upper portions of the trapezius muscles, muscles that lift the scapulae, sternocleidomastoid muscles, pectoralis minor and major muscles, weakness of the lateral serratus muscles, lower phasic portions of the trapezius muscles, appears. deep neck flexors. As a result, the neck and shoulders shift forward with increasing thoracic kyphosis. The sagittal and vertical dimensions of the chest increase, which leads to difficulty breathing and disruption of its central regulation, mainly due to the scalene and pectoral muscles. At the same time, tonic tension occurs in the iliopsoas muscles, the lumbar part of the erector spinae muscles, the tensor fascia lata muscles, semitendinosus and semimembranosus muscles, and weakness of the abdominal muscles, gluteus maximus and gluteus medius. The pelvic-costal gap decreases and the flexion position of the hip joints develops. The patient acquires a characteristic posture - the “Voltaire” pose. !!! --> An attempt to correct such a compensated posture, which makes the patient more resistant to the clinical manifestations of the disease, especially the use of dorsoventral mobilization at the top of the kyphotic deformity of the thoracic spine (kyphosis of the thoracic spine is often associated with the progression of osteoporosis), which leads to a decompensated exacerbation. !!! --> Therefore, in old age, the so-called techniques are mainly used. "soft" manual therapy. Joint manual therapy is used with caution; manual therapy alternates every other day with other methods of physical influence (massage, physiotherapy). Before, during and after manual therapy, the patient's condition is monitored. !!! --> In old age, it is better not to perform manual therapy at all, since the patient’s condition is “overloaded” with general somatic pathology. The journey to the doctor itself at this age is already a burden that can lead to a sharp deterioration in the patient’s condition, not to mention possible reactions to treatment.

Contraindication to manipulation. General contraindications to manipulative treatment should once again be clarified: signs of involvement of more than two adjacent segments or nerve roots in the lumbar region, elastic sensation at the end of joint movement and protective joint spasm, inability of the patient to relax. In all these cases, direct tissue damage is possible. Any signs of diseases of the spinal cord or cauda equina or their compression should be treated as an absolute contraindication for manipulation. This applies even to such mild symptoms as moderate bilateral paresthesia of the legs (Maitland G.D., 1970).

Consolidation of the MT effect. Complications of manual therapy in the form of relapse of blocking a motor segment or a violation of the motor stereotype can be caused by insufficient measures to consolidate the effect of manual therapy in the form of strengthening fixation of the affected motor segment, therapeutic and general physical training, optimization of household and work skills, a healthy lifestyle, timely and appropriate treatment diseases (including somatic or inflammatory) causing blocking of the motor segment, etc.

Complications that appear during treatment. Of course, one should pay attention to the patient's pain or resistance as a warning sign. If such signs occur, then the symptoms and diagnosis must be interpreted in a new way. This means that manual therapy should never be performed with pain or against blocking resistance. In this case, either the course of action or the indication for treatment is wrong. !!! --> In the few cases where manipulation was the cause of a violation, it was the doctor’s work against the clear resistance of the patient. The patient's tissue always knows best what is good for it, and we must listen to this. The less experience the doctor has, the more he should pay attention to pain or resistance as an absolute contraindication. !!! --> With more experience, some of the absolute contraindications can be considered relative.

Patient-related complications. Even if all the rules for selection for treatment are followed and safe and appropriate methods of therapy are used, there is always a patient factor that cannot be taken into account. For example, to an unusual change in sensations during and after treatment, the psyche and body of even a relatively healthy patient may react with a heart or vascular attack due to changes in hemodynamics, sudden straining at the time of manipulation. The patient may display unusual behavior due to psycho-emotional stress, for example, quickly jump up after treatment, contrary to the doctor’s recommendations, immediately after treatment and pain reduction, go to training, to the market, “run up” to transport, against the background of increased after treatment of range of motion: carelessly sitting down or standing up abruptly, etc. According to Maitland G.D., !!! --> if the patient, for some reason, is unable to follow the recommendations prescribed by the chiropractor to limit physical activity, maintain correct posture, etc., then it is better to refuse treatment, since the lack of a positive result may discredit the specialist. !!! --> Particular attention should be paid to contraindications associated with the patient’s neuroticism. Such patients are not able to relax during treatment and research, and are not able to fully follow the doctor’s instructions. Subsequently, they tend to conflict with the doctor and cause serious trouble to the attending physician. Examples of patients in whom treatment is prone to complications: patients with a psychological lack of tolerance to pain or discomfort, with emotional instability, with neuroticism focused on a disease of the musculoskeletal system, patients who have recently been treated by other doctors, litigious patients, psychological or emotional incompatibility between doctor and patient.

MT addiction. A change in sensations, the appearance of comfort, relief and general relaxation after a manual therapy session can form a behavioral dominant, which encourages the patient to seek an appointment without special need and solve their psychological problems with the help of a chiropractor, with a certain degree of persistence. Manual therapy can never replace psychotherapeutic care or psychological assistance. In any patient one can find certain deviations from the hypothetical “norm”, and if desired, one can always find an “object” for the doctor’s efforts. However !!! --> Frequent and prolonged sessions ultimately lead to hypermobility with frequent relapses of the pain syndrome and the patient’s physical dependence on this type of medical care. It can also be said that the doctor’s integrity is demonstrated at the beginning and end of a course of manual therapy. The pursuit of a “long ruble”, as a rule, ends badly for the patient and the doctor.”

Manual for doctors “Manual therapy” A. B. Sitel; M. "Rus" "Publishing Center", 1998.

Absolute contraindications to the use of manual therapy are as follows::

1 . Tumors of the spine, spinal cord, brain, joints, limbs, internal organs.
2 . Specific and nonspecific infectious processes in the spine and joints (tuberculous spondylitis, osteomyelitis, active rheumatism).
3 . Acute and subacute inflammatory diseases of the joints.
4 . Acute and subacute inflammatory diseases of the spinal cord and its membranes.
5 . Fresh traumatic injuries of the spine and joints.
6 . Condition after spinal surgery.
7 . Ankylosing spondylitis.
8 . Fragments of sequestered disc herniation (as a result of trauma).
9 . Disc myelopathy.
10 . Any factors that cause a sharp relaxation of blood vessels with an avalanche-like increase in the permeability of the vascular wall and, as a consequence, leading to the possibility of hemorrhagic permeation of the brain (infections, alcohol intoxication, increased blood pressure above 180 mm Hg).
11 . Acute diseases of the gastrointestinal tract, chest organs, acute disorders of cerebral and coronary circulation (stroke, heart attack, bleeding, acute inflammation, infections, etc.).

Relative contraindications include the following nosological forms and conditions:

1 . Vertebrogenic syndromes of spinal osteochondrosis in the acute stage.
2 . Instability of the vertebral segments, stage III. (spondylolisthesis more than 1/3 to the underlying vertebra, spondylolysis spondylolisthesis).
3 . Severe developmental anomalies (nonfusion of the vertebral arches, sacralization, lumbolization).
4 . Forestier's disease (fixing ligamentosis).
5 . Consolidated spinal fractures and traumatic injuries of intervertebral discs until callus formation (on average 6 months).
6 . Arthrosis III - IV degrees.
7 . Congenital developmental anomalies.
8 . Intercurrent diseases.
9 . Pregnancy over 12 weeks.
10 . Old age over 65 years (osteoporosis of bones).

When selecting patients for manual therapy, it is necessary, first of all, to rely on the clinical manifestations of the disease, clearly collect medical history data, especially about previous injuries (including perinatal), and take into account concomitant diseases. But the main criterion for the successful use of manual therapy is X-ray data and MRI.