Is Spinal Manipulation Safe for Lower Back Pain Relief?

Is it appropriate to perform spinal manipulation or lumbar stretching?

In the past year or two, I occasionally experience tightness in my lower back, and I find that rotating my torso from side to side helps to release some tension, often accompanied by audible sounds.
In October and November 2019, I noticed that the rotations felt deeper, and I had a sensation of forcibly turning.
In late December 2019, I sustained an injury while exercising, resulting in sharp pain in my lower back and numbness in my legs.
Initially, I sought physical therapy to adjust my pelvis, but the numbness persisted.
Later, I consulted a neurologist who reviewed my X-rays and diagnosed me with acute neuritis, indicating that my lumbar vertebrae L4 and L5 were compressed, necessitating traction therapy.

During the first week and a half, I underwent traction three times with the lightest weight of 50 pounds, pulling 13 to 14 times.
During this period, I also engaged in light jogging and jumping activities.
After my first traction session, the physical therapist noted some misalignment in my sacrum and adjusted it back into place.
However, after the third traction session, I experienced sharp pain in the area of my lower back that typically makes sounds when I rotate, especially when breathing.
I found that rotating my lower back helped alleviate the pain.

Subsequently, I experienced issues with poor circulation in my legs, as well as inflammation in my joints and ligaments, which led me to stop traction therapy.
From January 23 to the present, I have been resting more, reducing walking, avoiding exercise and twisting movements, and taking anti-inflammatory medications.
I have been able to perform daily activities without issues, but I still experience warmth in my calves when sitting and tightness in the muscles of both legs.
When I visited a rehabilitation specialist, they advised that I need to continue with traction therapy.

I would like to ask:
1.
Given my experience with rotating my lower back, is traction therapy suitable for me? Could it potentially lead to lumbar instability, or is it possible that my activities during traction caused this issue? Would simply using a back brace after traction be sufficient?
2.
Can a non-contrast MRI reveal issues related to my lower back rotation, such as my perception of increased mobility in my lumbar vertebrae?
3.
An orthopedic specialist mentioned that my left nerve is more compressed and advised more rest.
Would traction exacerbate this nerve compression?
4.
When experiencing inflammation in the hip joint and surrounding muscles and ligaments, even with pain relief and anti-inflammatory medications, I still feel sharp pain in my lower back and buttocks.
Would undergoing traction in this state worsen the inflammation?
5.
If my sacrum and coccyx are misaligned, can traction correct this?
6.
During traction therapy, is it advisable to also undergo spinal manipulation? Why or why not? The rehabilitation doctor mentioned it was permissible but did not explain the reasoning.
Thank you.

Chen, 20~29 year old female. Ask Date: 2020/02/17

Dr. Wang Zhaomin reply Rehabilitation

1.
Lower back rotation that produces sound generally does not lead to a strain, but individual conditions may vary, and there is indeed a risk of disc herniation; therefore, clinical evaluation is necessary for proper assessment.

2.
Magnetic resonance imaging (MRI) is a static examination and cannot reveal dynamic issues; however, if abnormalities are found in the static images, they may help explain related phenomena.

3.
Lumbar traction is intended to improve the degree of narrowing and prevent further deterioration.

4.
Lumbar traction can alleviate nerve compression and reduce inflammation; taking anti-inflammatory and analgesic medications can also be beneficial.

5.
The traction force acts on the lumbar vertebrae and does not affect the sacral or coccygeal vertebrae.

6.
Spinal manipulation is similar to lumbar traction but should be performed by a qualified professional to avoid injury.

Reply Date: 2020/02/17

More Info

Spinal manipulation, often referred to as chiropractic adjustment, is a common treatment for lower back pain. However, its safety and efficacy can vary based on individual circumstances and the underlying causes of the pain. Let's address your questions and concerns regarding spinal manipulation and its implications for your lower back pain.

1. Is Spinal Manipulation Suitable for Your Condition?
Given your history of lower back pain, particularly the acute nerve inflammation and the sensation of your spine being misaligned, spinal manipulation could potentially provide relief. However, it is crucial to ensure that the manipulation is performed by a qualified professional who understands your specific condition. If there is a risk of lumbar instability or spondylolisthesis (slipping of one vertebra over another), spinal manipulation might exacerbate the issue. Therefore, it is essential to have a thorough evaluation by a healthcare provider, preferably a spine specialist, before proceeding with any manipulation.

2. Can MRI Detect Issues Related to Spinal Movement?
An MRI without contrast can reveal structural abnormalities in the spine, such as herniated discs, spinal stenosis, or other degenerative changes. However, it may not specifically show functional issues like excessive mobility or instability during movement. If you feel that your lumbar spine is overly mobile or unstable, discussing these sensations with your doctor is vital, as they may recommend further imaging or functional assessments.

3. Does Spinal Manipulation Affect Nerve Compression?
If you have a narrowed nerve passage (neuroforaminal stenosis), spinal manipulation could potentially aggravate your symptoms. Manipulation may increase pressure on already compromised nerves, leading to heightened pain or discomfort. It is crucial to discuss your specific nerve condition with your healthcare provider to determine if manipulation is safe for you.

4. Impact of Inflammation on Spinal Manipulation
If you are experiencing inflammation in the hip joint or surrounding muscles and ligaments, even with anti-inflammatory medication, manipulation could potentially worsen your condition. Inflammation can make tissues more sensitive, and manipulation might lead to increased pain or discomfort. It is advisable to wait until inflammation subsides before considering spinal manipulation.

5. Can Spinal Manipulation Correct Misalignment?
Spinal manipulation may help correct certain misalignments, such as those in the sacroiliac joint or lumbar spine. However, the effectiveness of manipulation in correcting chronic misalignments or structural issues can vary. A comprehensive assessment by a healthcare professional is necessary to determine the best course of action for your specific misalignment.

6. Can You Combine Spinal Manipulation with Other Treatments?
It is generally acceptable to combine spinal manipulation with other treatments, such as physical therapy or medication, as long as it is done under the guidance of your healthcare provider. Each treatment modality can complement the others, but it is essential to communicate openly with your healthcare team about all treatments you are receiving.

In summary, spinal manipulation can be a beneficial treatment for lower back pain, but it is not without risks, especially in cases of underlying conditions like nerve compression or instability. Always consult with a qualified healthcare provider who can assess your specific situation and recommend the most appropriate treatment plan. Additionally, consider incorporating other conservative treatments such as physical therapy, exercise, and lifestyle modifications to support your recovery and prevent future episodes of pain.

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