Spinal manipulation and other tools

When it helps, it’s ever so nice

And for me, it’s not about price

For the old spinal crunch

Can sure help a bunch

I’ll manipulate, but not more than twice.


Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

For the most part I approach medicine in a go-by-the-book fashion. But I keep an open mind, and I try to keep more than a passing acquaintance with what has been called “fringe medicine.”

I took a month’s course in acupuncture as a senior in medical school, but it would take decades and much research it to gain anything like acceptance. We now have more evidence to support the treatment of chronic pain with acupuncture than with opioids (also known as narcotics), yet many more docs use the opioids than the needles.

Honey as a cough suppressant has become a mainstream recommendation.

I went to Michigan State, which has an MD school right next to an Osteopathic school. We shared most of the basic science classes in the first two years, and twelve members of my class demanded teaching in osteopathy.  We met for an hour twice a week in a basement, and we practiced on each other.

In fact, I learned spinal manipulation even before I finished premed. You could call the crowd I ran with “nerds” or you could note that we shared information whenever we could.  But I learned how to feel where other people hurt, and I learned how to crunch backs.

At Michigan State they taught me when to and when not to use the technique. I also learned what they called “muscle energy” manipulation; the technique is also known as “push-pull” or “strain-counterstrain.” You can improve range of motion if you move the affected part to the barrier, then have the patient do an isometric contraction away from the barrier.  I use the technique, for example, after prolonged immobilization in a cast renders a limb stiff.  But it also works when spasm limits mobility.

(Properly done the technique is more complicated than I have described. Please do not try it at home.)

When our oldest daughter contemplated medical school, I steered her towards the DO track; those tools come in handy in primary care. And so far this week I have used them several times, making the patients better before they got out the door, and teaching them how to use the tool in the future.

But the power of manipulation must be used with respect.

In another clinic in another town in another country, a while ago a patient came to me with classical back pain. His chiropractor twice had helped a lot but only for a couple of days.  I crunched him twice, with good relief.  But when he came back the third time, I stuck to my guns, and, rather than manipulating his spine, I sent him for a CT scan.  I could not have imagined beforehand the very grim diagnosis.


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One Response to “Spinal manipulation and other tools”

  1. ericjs Says:

    That “muscle energy” manipulation sounds related to the basis of “Clinical Somatic Education”. I would highly recommend you check out the book Somatics, by Thomas Hanna.

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