Non-Manipulative treatment for back, hip or neck pain.
Thomas K. Ockler P.T.

Manipulation has long been used by a multitude of practitioners as a means of correcting painful somatic asymmetries. Osteopaths, Physical Therapists, Mechano-Therapists and Chiropractors to name the top 4. There has always been some degree of scepticism and adversity by the general medical community as well as the public, largely due to injuries and the tendency to over treat even when no benefit has been attained.

Some 40 years ago, Osteopaths theorized that manipulation may not be all it was "cracked up" to be and they began developing alternative ways to accomplish this. In the process, they developed techniques with even better outcomes, without the risks of injury and so effective that over treatment would be self limiting.

Two of these techniques are Muscle Energy Technique and Strain Counter Strain. The hallmark of these techniques is that they do not involve any type of thrusting or manipulations and, they actually address the true, cause of the dysfunction and not just the symptoms.

For starters, those people who only know how to manipulate would like the public to believe that some bone is stuck out of place as though by a "mysterious physiologic sticky glue which keeps the joint / bone out of place. They tell us that manipulation is the most effective tool available to correct this and further more, the force of the manipulation miraculously breaks this sticky glue up. If that were the case, does the glue then re-form overnight and that is why you need to keep going back for more manipulations over and over again? I have never seen one scientific report that supports this theory. At autopsy, no evidence of mysterious sticky glue in joints has ever been documented but...plenty of evidence of tight muscles and fascia / connective tissue has been reported during surgeries, at autopsy as well as during physical exams.

So how come you sometimes feel good after a bone or joint gets cracked? Some of us at one time or another have cracked our own back or neck and notice a "good feeling." Some people even feel sort of "high" from the crack.

Why is that? 

When you traumatize a joint, the body's natural response is to produce endorphins. An internal chemical cousin of morphine. It is the substance that runners talk about when they get a "runner's high." When Granny rocks her rocker on the front porch, it is the rocking action that also produces "the morphine within" which helps to get rid of some of her arthritis pain. So, when you crack or get cracked, manipulated, your body produces your own morphine not only at the spinal level but also in the brain itself. 

If you've been in pain for some time, your body already has circulating endorphin floating around to help you deal with the pain. So why traumatize the body to try and fix it? Doesn't make sense to me either.

So where is the problem? The true cause of painful somatic dysfunction is due to muscles that have been accidentally programmed to have too much tension and are too sensitive to stretch. CASE CLOSED.

These techniques that I mentioned previously were developed even before they knew for sure how they worked. 40 years ago equipment did not exist that was sophisticated enough to measure electrical action potentials in tiny little organelles called muscle spindles. These little "physiologic computer chips" are located throughout the musculo-skeletal system and tell your brain and spinal cord important information about how much tone and tension is present and necessary to accomplish any given task. Problems occur when these little computer chips get bad information from slips, falls, overuse and accidents. Correct the muscle spindle and the muscles / connective tissue and tension is put back to "factory settings." The bone or joint that is being HELD out of place ( not stuck out of place) then goes back to normal function and position. 

The techniques have been refined over the years as more and more practitioners began learning them such that they are now more effective and efficient than in their original form. So much so, that if done correctly, it takes two or three visits to correct the dysfunction. NOT 20 or 30. 

This is all well and good if manipulations actually corrected the problem after 20-30 visits. Great, your fixed go forth and live a pain free life. Even though your pocket book is lighter, you're still fixed and all is right with the world. Guess what though, repeated manipulations can actually harm your body by making the ligaments and joint capsules over stretched, traumatized and unstable. There have been, from the beginning of modern manipulative time, contra-indications for manipulations.

Example #1: On the first day of manipulation 101, future back crackers learn to never manipulate the back unless they first rule out the presence of a spinal disorder called Spondylolisis and it's evil counterpart Spondylolisthesis. That is why they take an X-Ray first. Not to "check your alignment" as you are led to believe, but to check for one of these spinal defects. (By the way, an experienced clinician can check your alignment by looking at and touching your body during an exam.) To manipulate in the presence of one of these disorders is to risk catastrophic injury. But Spondylolisthesis is not a contraindication with Muscle Energy Technique and Strain Counter Strain. 

Example #2: Sometime on day one of Manipulation 101, future neck crackers are warned to first check the neck of the prospective "crackee" for a disorder called Vertebral Artery Syndrome. This involves a brief screening for a potentially lethal problem with the blood supply into the base of the brain that may be compromised by sudden turning or extension of the neck. If the neck of someone with positive signs for VAS is manipulated, the artery to the brain can be torn and the patient can suffer blackouts, stroke and even death. The symptoms may not materialize until hours and in some cases a day or two after the damage has occurred so the patient may die at home or on the way home and no one figures out how it occurred. Surprisingly, I have never met a patient who said they were checked for VAS prior to manipulation of the neck even though I have found strong evidence of VAS. But, VAS is not a contraindication for Muscle Energy Technique and Strain Counter Strain.

There is a down side to these techniques thought. (Ah Haaaa!!!) There are very few practitioners who can perform them well enough to get consistently positive results. But trust me, these rare individuals are well worth the search. 

So to summarize,

Manipulations:

• Address non proven mysterious hypothetical sticky joint glue.

• Are usually boasted they will require at least 10-15 visits.

• Can potentially harm the patient instantly or the effects may accumulate and not become evident until years down the road.

• Are contra indicated for several dangerous hidden spinal defects.

• Can easily be performed in 30 seconds per visit.

• Will gladly be done on any unsuspecting person in thousands of locations the world over.
  
  Muscle Energy and Counter Strain:

• Have virtually no contra indications.

• Correct the cause of the somatic dysfunction.

• Use such tiny muscle contractions / forces such that there is no chance of disturbing unseen spinal defects.

• Actually will help to stabilize instabilities caused by multiple manipulations.

• Require very few treatments to accomplish the goals of pain elimination.

• Can only be done by a precious few, highly skilled practitioners.

• Are much more difficult to learn and perform correctly than manipulations.

• Require the practitioner to spend more time with you.

Thomas K. Ockler P.T
www.tomocklerpt.com

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