What are the self-care and medical approaches to spinal joint dysfunction?

Self-care for the client/patient with spinal joint dysfunction

Self-care for the client/patient with spinal joint dysfunction is usually focused on addressing whatever the cause(s) of the condition is/are. Client/patient posture is often involved, so advice for proper posture should be given. As a rule, moist heat followed by stretching is beneficial for spinal hypomobilities, and strengthening is beneficial for regions of spinal hypermobility.

Medical approach for spinal joint dysfunction

Spinal joint dysfunction is usually not recognized by the medical community unless the regions are great enough to affect gross range of motion. In these cases, physical therapy will usually be recommended. If the client/patient has an acute hypermobility of the cervical spine (for example, as a result of a whiplash injury) a cervical collar will often be recommended.

Hypomobile joint dysfunction is the primary focus of the chiropractic profession (as well as many osteopathic physicians). Their approach to treatment will be Grade V (fast thrust) joint manipulation. This type of manipulation is identical to Grade IV mobilization except that a fast thrust is introduced into the tissues instead of a gentle and slow oscillation force. Note: A Grade V manipulation is more efficient and effective at reducing a hypomobile spinal joint than a Grade IV mobilization. Therefore, if you assess a hypomobile joint in your client/patient and the client/patient does have a chiropractic physician, referral to the chiropractor could be recommended. However, for clients who do not work with a chiropractor, Grade IV mobilization might take a little longer than Grade V manipulation, but can eventually reduce the hypomobility.

Manual therapy case study for spinal joint dysfunction

Juliet is a 28-year-old dancer who has come in for a general deep tissue full-body massage. During the history, Juliet states that she has no outstanding musculoskeletal conditions. The only problem that she occasionally experiences is tight muscles from overexerting when dancing.

Anterior glide mobilization of the cervical spine. Permission: Joseph E. Muscolino. Advanced Treatment Techniques for the Manual Therapist: Neck (2013).

Anterior glide mobilization of the cervical spine. Permission: Joseph E. Muscolino. Advanced Treatment Techniques for the Manual Therapist: Neck (2013).

The therapist performed a physical examination. Static postural assessment showed symmetrical posture. No restricted motions were found with trunk and neck range of motion assessment (in fact, Juliet had increased ranges compared with the general population). All orthopedic assessment testing for space-occupying conditions was negative. The only positive findings were hypomobility into left lateral flexion at the C5-C6 joint, and a myofascial trigger point located deep in the laminar groove on the right side at that level.

Given the client’s/patient’s desire for a full-body deep tissue massage, and the fact that the therapist found only one level of joint dysfunction with an associated trigger point, the therapist recommended performing the full-body massage but with a few extra minutes focused on the region of hypomobility in the neck. The therapist also recommended that Juliet return once per week for four weeks.

The session was carried out as a full-body massage, but the last 10-15 minutes were spent working on the client’s/patient’s neck bilaterally. The therapist began with mild pressure, but quickly segued into medium pressure. This was followed by stretching the client’s/patient’s neck into all ranges of motion and then tractioning the neck using a towel. The therapist then performed joint mobilization at the C5-C6 joint into left lateral flexion; three sets of three to five oscillations were done. The therapist finished the treatment with deep pressure stroking massage along the trigger point and then repeated stretching the neck into lateral flexion in both directions.

This approach was repeated at the next three sessions, with the intensity of all modalities increasing with each treatment as Juliet’s neck gradually loosened. At the end of four weeks, Juliet’s joint hypomobility was completely resolved. Because of the success in having her neck worked, Juliet decided to return for clinical orthopedic massage every couple of weeks.