Resolving back pain through spinal manipulation

19 July, 2010 at 22:35 4 comments

When most people think of spinal adjustments, they will most likely associate this with having the vertebrae bones in the spine being “clicked” or “cracked” into alignment by a chiropractor, osteopath or physiotherapist.  There are also different “grades” of adjustment or manipulation ranging on a scale from 1 thru 5, with 5 being the most radical in terms of movement range adjustment and thus requiring the most amount of applied manual force directed at the joint.  Generally, a grade 3, 4 or 5 adjustment will be carried out by a licensed chiropractor, osteopath or physiotherapist and involve moves that are known in the trade as High Velocity Low Amplitude (HVLA) adjustment techniques – also sometimes called High Velocity Thrust techniques depending on the profession you speak to.
What most people don’t realize is that a completely spontaneous physical adjustment of the spine (or any other bone to bone joint for that matter) can occur and often does during a remedial or clinical massage session, or indeed in any situation where the soft tissue interconnecting with the joint in question is being manipulated in a precision and focused manner.  Indeed, you wouldn’t necessarily go to your massage therapist asking them specifically to manipulate or adjust your spine for you in the same way that a chiropractor or osteopath might do for example as it’s usually beyond their scope of training and practice.   However, equally beneficial indirect and spontaneous bone joint adjustments can and do occur during clinical massage and soft tissue work such as fascia release, and as well as being a lot gentler than high velocity thrust adjustments, these spontaneous adjustments themselves occur because a number of other bio-mechanical conditions (as well as mental states) have aligned themselves within that person that has allowed that change to take place – that person and their being was “ready” to allow that particular change.  Sometimes but rarely direct manipulation is required as a last resort, but even among prominent and highly experienced osteopaths and chiropractors, there are those who have ditched this part of their training and instead have exclusively taken to the softly softly approach with consistent success and hardly ever go back to performing direct physical manipulation of bones.
If you have not yet read our articles on the Psoas and Quadratus Lumborum muscles, please feel free to click the aforementioned links to convince yourself that these 2 very major muscles which attach to the spine can have a significant effect on lower back pain symptoms as well as being able to bear significant load on the spine itself and thus causing potential alignment deviation.  Precision massage therapy offered by therapists trained in clinical massage can of course help release and balance tension in these deep muscles of the lower back.
The intrinsic muscles of the spine which we have not devoted specific articles to are the erector spinae and transversospinales muscle groups, below is a diagram showing the complexity of these 2 muscle groups and their relationship with regards to their attachment points on the spinal column plus the other msucles which we have already discussed previously:
Trigger point pain pattern charts and diagrams are included below to complete this discussion on the soft tissue approach to spinal adjustment and alignment:

Entry filed under: Clinical Massage & Bodywork. Tags: , , , , , , , , , , , , , , .

Important Muscles Involved in Lower Back Pain – Part 3 : Rectus Abdominus Healing Back Pain the Emotional Way

4 Comments Add your own

  • 1. ThetaHealing Practitioners TV – Intuitive Anatomy  |  29 July, 2010 at 16:08

    […] Resolving back pain through spinal manipulation […]

  • 2. Jonathan Boxall  |  19 September, 2010 at 01:28

    Hi Henry,

    I am a bit confused by this article. On the one hand it seems to imply that clicks noticed as!”spontaneous” during massage therapy are a good thing, but that those experienced during spinal adjustments in the hands of a trained and skilled practitioner are somehow forced and that the body is not ready. Is it possible that the massage therapist has intuitively stumbled upon the right thing to do, and that it is possible to take this further once the biomechanics of the joint are better understood? It would be a shame if the four years I spent practising this were just a refined way of abusing patients!



    • 3. Henry Tang  |  19 September, 2010 at 19:13

      Hi Jonathan,

      Great to have your input and contribution on this, especially as we’ve swapped treatments with one another so we each have at least have some degree of experiential understanding of what the others working style involves.

      My aim was to make the article as impartial and neutral as possible. The main emphasis was to alert the lay person to the fact that “some” practitioners may be only addressing 50% of the equation and leaving the other 50% out. Thereby necessitating perhaps unnecessary repeat visits for adjustments which eventually relapse. So the 50/50 equation I elude to is direct mechanical bone manipulation of the joint intersection vs manipulation of the soft tissues holding that joint together.

      I have 2 friends who are currently undertaking osteopathic training at 2 different colleges so have a certain amount of awareness of the breadth of the curriculum content of their respective courses. I don’t doubt for one second the content and efficacy of your training because I have experienced a treatment with you and know that you make use of a wide range of tools from your tool box and don’t just concentrate exclusively on High Velocity Thrust adjustment techniques of the spine which some people I know have experienced and have (misrepresentingly) taken away with them thinking that that is all there is to a visit to a chiropractor or osteopath.

      I know of a chiropractor in our area, having met him on the networking scene, who also has training in and practices myofascial and soft tissue work in his treatments. He has also trained in some osteopathic techniques too. So that brings me to another point that I was making in the article, that the label a practitioner goes by doesn’t necessarily tell the full story until you start investigating what other trainings they’ve invested in during their career to date.

      Having heard reports from a number of clients who have come into see me after visiting other physios, chiropractors or osteopaths in the area, I often ask myself, did that other practitioner really utilize all the knowledge imparted upon them in their 4 to 5 year qualifying course? Perhaps that is a challenge for some (practitioners), faced with the sheer breadth of choosing which tools to use from their training?

      When is our logical judgement based on conventional understanding of bio-mechanics and the use of some kind of physical force better than using intuition or creating a situation of facilitated allowing for the body to make its move in its own good time? That’s a difficult and philosophical question, only answerable by one’s own personal experience I feel! Not a very objective “scientific” answer, but one which has nonetheless produced benefits that are observable by the clients that I’ve worked with anyhow!!! Just like, is direct or indirect myofascial work better? Well, from my experience they both seem to work and apply themselves more beneficially dependent upon the situation or scenario.

      If you are interested in working together as a referral partner, I would certainly be happy on onward referring my clients your way when the need arises?



  • […] Resolving back pain through spinal manipulation July 2010 3 comments […]


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Henry Tang – Therapeutic & Advanced Clinical Massage Practitioner (Crows Nest, Sydney, Australia)

Click image above to visit Spaces of Possibilities Wellness Centre, Crows Nest, Sydney, Australia.

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