Q&A Time! How Do I Get Patients to Stop Self Manipulating Their Spine? | Modern Manual Therapy Blog

Q&A Time! How Do I Get Patients to Stop Self Manipulating Their Spine?

Let's get some myths out of the way first....

Is it safe to repeatedly manipulate your spine?
  • there are no studies that demonstrate repeated manipulation of the extremities or spine lead to degeneration, laxity, or instability
  • that would be like saying stretching does the same thing, or repeated end range loading, and they do not either
Is it effective to relieve pain or increase mobility?
  • the best inputs are ones the brain considers novel
  • after a while, especially if your patient feels the need to crack their neck, hip, or back, the need will increase to get the same "relief"
  • this is due to accommodation, which happens with any repeated stimulus
  • in other words, I educate patients that if you really "needed" to do this, and it had any kind of permanent relief, you would not be here
  • this has to be emphasized with a healthy dose of Pain Science, regarding things not going in/out of place, etc...
Many years ago, I would have just gotten patients to perform their own repeated loading strategy and basically told them that this replaced the need to self manipulate. I erroneously disregarded their preference and the feeling of satisfaction they got from a manipulation. In some patients, this was effective, as they got relief; in others, where the need and belief was stronger, it was much less effective, or they continued to self manipulate.

A strategy I use now still involves 
  • pain science education
  • repeated end range loading in regular doses
  • avoidance of motions/positions that temporarily increase their complaints
  • telling them to be mindful
Mindfulness is used in many conditions from persistent pain, to addiction. If you feel the need to yawn, or to eat,  just "let it pass;" be mindful of the need, and you will realize that the "need" goes away. You no longer have the craving. If you do not feed the need for long enough, the need reduces or goes away. This has been an effective strategy to get patients to stop self manipulating. It's not an issue because it's unhealthy, promotes hypermobility, or any of those old school beliefs. However, the craving itself may be promotion of some Thought Viruses that things need to be put back into place in order to move and feel well.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...


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