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(FAQs) Joint Manipulation

What is joint manipulation?

Joint manipulation is a treatment modality that has become largely ubiquitous with chiropractic care.  Commonly referred to as an “adjustment” by chiropractors, the reality is that joint manipulation is practiced by multiple healthcare disciplines including chiropractors, physical therapists, osteopathic doctors, and some medical doctors.

Joint manipulation is often associated with a “cracking” sensation in the targeted joint(s) that is more appropriately referred to as a cavitation.

What is the difference between joint mobilization and joint manipulation?

The major difference is that joint manipulation tends to be associated with a “high velocity” thrust or pull on the targeted joint, whereas joint mobilization is usually a slower velocity thrust or pull.  There is currently not any evidence that clearly indicates one variation is better than the other.

Dr. Melander utilizes both joint mobilization and joint manipulation with patients every day.  He chooses which technique to use based on the underlying condition, severity of pain, and sometimes patient preference.

    What is the purpose of joint mobilization?

    The purpose of both joint mobilization and joint manipulation is to passively increase range of motion of the targeted joint(s).  Based on patient presentation and a range of motion evaluation, Dr. Melander may utilize either joint mobilization or joint manipulation (often both) in order to improve the range of motion of a restricted joint.

    In many situations patients are experiencing discomfort, pain, or stiffness due to restricted joint range of motion.  In those situations a mobilization or manipulation will often provide immediate relief and improved range of motion.

    Types of manipulation?

    Truly, there are endless types of joint manipulation usually named after some provider who developed a strong following or earned particular success over the years.  Dr. Melander graduated from the Palmer College of Chiropractic Florida Campus, and as with all Palmer graduates, he is trained in the “Palmer Package”.

    The Palmer Package refers to 4 joint manipulation styles: Diversified, Thompson-Drop, Gonstead, and Toggle Recoil.  Dr. Melander tends to use Diversified or Gonstead style manipulation in the overwhelming number of scenarios.

    That being said, joint manipulation is just another tool in the toolbox, and there are many instances where manipulation is contra-indicated for a patient or condition.

    Joint Manipulation Techniques

    Sacroiliac joint manipulation: In situations of lower back pain that may be related to “sacroiliac joint dysfunction”, joint manipulation is utilized to help improve range of motion in the restricted joint.  Often times a patient will present with lower back pain that worse to the left or right, with tenderness along the sacroiliac joint of their pelvis.  In these situations, Dr. Melander may perform a sacroiliac joint manipulation to help get some relief for his patient.

    Knee joint manipulation:
    Dr. Melander does not tend to perform joint manipulation on the knee, although occasionally may manipulate the fibular head slightly below and to the outside of the knee.

    Joint manipulation massage techniques:
    Joint manipulation and massage are 2 different treatment styles.  Joint manipulation is apt to change the mechanics of a joint system, whereas massage is utilized to influence muscle and connective tissue.  That being said, in countless scenarios Dr. Melander utilizes soft tissue mobilization techniques (IE: massage) coupled with joint manipulation to try and change his patient’s condition as efficiently as possible. 

    Shoulder manipulation:
    Dr. Melander does not tend to use manipulation techniques for the shoulder due to unstable nature of the shoulder joint.  Dr. Melander prefers a combination of soft tissue mobilization and strengthening to help remedy shoulder problems.

    Neck manipulation:
    Dr. Melander performs neck manipulation for many patients with neck pain and headaches following a thorough examination to be sure it is safe to do so.

    In fact, due to a tendency in his youth to experience headaches Dr. Melander would often see a chiropractor as nothing else would match the relief experienced immediately after a neck adjustment. 

    What are the benefits of joint manipulation?

    The overriding benefits of joint manipulation are improved range of motion and decreased pain.  Many people due to the mechanical strains inherent to their lifestyle and activities may develop restricted range of motion in a joint or joints, and joint manipulation is one of many treatment styles that can be used to improve the mechanical function of the joint.

    General FAQs about Joint Manipulation

    What happens during spinal manipulation?

    During spinal manipulation Dr. Melander will perform a high velocity thrust or pull on a targeted joint or joints.  The patient often hears and feels a cracking sensation known as cavitation.  There is rarely any pain associated with a joint manipulation, and there is frequently immediate relief experienced by a patient after a joint manipulation. 

    Is spinal manipulation safe?

    Yes, quite safe in fact.  As with any health care intervention there are occasional side effects but the instances of these side effects are extremely rare, and most often related to soreness after a treatment.

    That being said, there are absolutely examples of manipulation having been performed on an individual for whom it was not safe to do so, and these situations can result in fractures, disc injuries and aggravated pain. With a proper evaluation and patient history however, a well-trained provider should be able to negate almost any likelihood of adverse reactions.  

    There have been some cases shared by the media regarding an association between neck manipulation and stroke, but the research indicates there is less than a 1 in 1Million likelihood, and more than likely the patients affected in these situations were experiencing a “stroke in evolution” prior to initiating care.

    Is manipulation therapy the same as chiropractic?

    Chiropractors are just a subset of healthcare providers who may use manipulation to try and help their patients.  By no means is manipulation unique to only chiropractors.

    What does subluxation mean?

    The term subluxation in medical terminology means “partial dislocation”.  For many years (and unfortunately still to this day), chiropractors described spinal joint fixations that necessitated joint manipulation as “subluxations”.

    Those same chiropractors believed that subluxations were the root cause of all disease despite absolutely no research supporting those beliefs.  Dr. Melander does not use the term subluxation in his practice, except in the absolute truest examples of partial joint dislocation.

    What is soft tissue manipulation?

    Soft tissue manipulation refers to any massage-like technique used to influence a change in muscle and connective tissue.  Soft tissue manipulation is altogether different than traditional joint manipulation.

    Curious about joint manipulation?  At North Shore Spine and Sport Dr. Melander utilizes joint manipulation daily to help his patients.  Call, text, or email to learn more. 

    our Chiropractic

    Dr. Melander has often described his work as new-school rehab, which is to say, an amalgamation of current best practices regarding pain or injury management, hands-on manual therapy or strength/mobility training, and endless advocacy and support for his patients.

    In Dr. Melander’s opinion, the best providers in the field of musculoskeletal injury are able to draw from multiple disciplines to create the most efficient and impactful care strategy for their patients.  If you are injured or hurting and not sure what to do, please reach out, it will be our greatest pleasure to help you. 

    We serve Newburyport and surrounding North Shore communities, including: Newbury, West Newbury, Rowley, Byfield, Georgetown, Amesbury, Salisbury, Ipswich, Seabrook NH, Hampton NH, Rye NH.

    Headache Relief

    Cervicogenic (neck generated) headaches are often helped immediately by manipulation 

    Low Back Pain Relief

    Research shows manipulation can be helpful in certain varieties of lower back pain 

    Pain Relief

    The number one reason people see chiropractors all over the world

    Improve Joint
    Range of Motion

    Manipulation can help joints move better through restricted ranges

    Improve Recovery

    Manipulation can help improve recovery and keep you active

    Decrease Muscle Tension

    Manipulation can reduce muscle tension due to connectivity of muscle and joint   

    Chiropractic FAQs

    We've compiled a list of common chiropractic questions to help you get all the answers you are looking for. If you have additional questions if our chiropractic and treatment services in North Shore would be a good fit for you, please contact our team. 

    How do I know if I should see a chiropractor?

    Chiropractors are trained in the evaluation and management (IE: treatment) of issues affecting the neuromusculoskeletal system (muscles, joints, connective tissue, nerves).  Many people associate chiropractic care with the spine only, but this is an inaccurate reflection of many chiropractors in the 21st century who are experts in treating spinal issues AND extremity issues (arms and legs).  As a general rule of thumb, if you have a painful condition that does not get better given a few days of activity modification you may want to consult a professional like a chiropractor.  Your chiropractor should be able to evaluate your painful condition, offer you some perspective and guidance relative to the painful condition, and help you care for the painful condition if treatment is warranted.  Like any profession though, each chiropractor has different clinical experience and different post-graduate education that may lend their practice toward a focus on sports injuries or pregnancy/neonatal care or neurologic issues or nutritional issues to name just a few.  If you are considering seeing a chiropractor, make sure that their experience and skill set seems like a proper match for your complaint and your ultimate goals.

    How do I choose a good chiropractor?

    Choosing a good chiropractor does not have to be a complicated process.  To begin with, ask your friends or family if they know someone they trust and can vet for you.  Next, check online as most chiropractors should have fairly informative websites relative to their clinical interests and experience that may help indicate whether they are a good fit for your issue.  If you are still not sure who to see after taking those steps, call your prospective chiropractor’s office as either the staff or the chiropractor will be more than happy to answer any questions and tell you if your issue is something commonly treated in that office.  Many people also like to read online reviews and while some online reviews can be misleading, if the significant majority of a chiropractor’s reviews are super positive then chances are you can trust the expertise of that provider.  Lastly, and arguably the most important step in choosing a good chiropractor, remember that you are in total control of your healthcare decision making.  If you go to an initial or follow-up appointment and you are not absolutely confident in the assessment and plan your chiropractor has rendered, then seek a second opinion.

    What can a chiropractor fix?

    A chiropractor can help you fix a wide variety of painful conditions related to the neuromusculoskeletal system such as headaches, back/neck pain, shoulder/elbow/wrist/hand pains, hip/knee/ankle/foot pains to name just a few.  Injuries of actual orthopedic compromise like fractures are best handled by orthopedists, but chances are if your pain/injury is non-surgical in nature then a chiropractor may be a great option to help you.  The best chiropractors will explain what they can about your pain/injury, offer guidance and likely treatment as efficiently as possible (days to weeks, maybe months in extreme situations), and then remove themselves and let your brain/body do the rest.  A great deal of research these days indicates that in many healthcare interactions providers should try and limit their patient’s dependency on them, opting instead for interventions and language that fosters resiliency and self-efficacy (independence).

    What happens at your first chiropractic appointment?

    Your first chiropractic appointment should include a detailed discussion of your health history and presenting complaint(s), an examination of your complaint(s), a discussion regarding what is indicated by the examination relative to prognosis and treatment plan, and finally some form of treatment/intervention assuming time permits.  Many painful conditions can be evaluated thoroughly and completely in a matter of minutes and certain treatment interventions could yield immediate relief, while other conditions may require more complex evaluations and more lengthy treatment plans.  Above all, you should leave your first chiropractic appointment feeling confident that your chiropractor is the best option to help you with your problem and you should leave feeling confident that you are on the road to recovery.

    How often should you see a chiropractor?

    You should see a chiropractor as often as you want or need.  Perhaps the most common criticism of chiropractors is that chiropractors “need to see you for the rest of your life”, and while there are unfortunately examples of chiropractors who advocate for this kind of dependency, the significant majority of chiropractors today want to help you as quickly as possible with no long-term commitments of any kind.  The best chiropractor will see you the minimally necessary number of times to help you overcome your issue and suggest you follow-up if there are any residual issues or new complaints sometime in the future.  Many patients however recognize how good they feel after chiropractic care and therefore wish to see their chiropractor with some kind of recurring frequency (IE: once/month, twice/year, or more).  These examples though should be dictated by the patient based on their assessment of their body’s needs and absolutely not dictated by the chiropractor based on some kind of pseudoscientific reasoning.

    Does insurance pay for chiropractor?

    In many cases, yes, insurance will help pay for chiropractic care assuming the chiropractor is participating with your health insurer.  If your chiropractor is not participating with health insurance, then it is still possible you have an out-of-network benefit with your insurer and can seek reimbursement that way.

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