A chiropractor – the specifics of a doctor’s work and what does he treat?

Back pain, neck pain, frequent headaches, stiffness and limited movement - these symptoms of diseases and disorders of the musculoskeletal system are experienced by 41% of the world's population, regardless of age. Some go for a massage, some take medications, but most do nothing, hoping that it will go away on its own. It won't work...

Today, the most effective way to overcome pain and stiffness in the back and neck is through manual therapy sessions. The advantage and distinctive feature from other treatment methods is that manual therapy acts on the root cause of the disease, and does not simply relieve symptoms for a short period of time. Until the mid-90s of the last century, manual therapy was considered one of the methods of traditional medicine, but at the moment, it is a full-fledged treatment method accepted by the World Health Organization.

In manual therapy, only hands are used, gentle practices and methods are used aimed at achieving maximum effective results.

What is manual therapy?

Manual therapy is a mechanical effect on the human body, carried out by the hands of a doctor, which has a wide and varied practical application. The effect is on the spine, joints, skin, muscles, ligaments, internal organs, blood vessels, and nerves. The goal of manual therapy is to eliminate the limitation of mobility in those areas of the body where mobility, for whatever reason, has decreased; relieve internal tension in organs (primarily in muscles, but also in blood vessels, internal organs, skin, ligaments and even bones), eliminate stagnation of biological fluids such as blood, lymph, interstitial fluid, intracranial fluid. Since I am a vertebrologist, this article will focus on problems of the spine and the musculoskeletal system in general.

Possible complications

Manual therapy is a safe and effective method of treating diseases of the spine and internal organs. But if its techniques are performed incorrectly, dangerous complications may develop:

• ischemic stroke as a result of compression of the artery supplying the brain;
• poor circulation in internal organs;
• infringement of intervertebral hernia and nerve endings;
• muscle and ligament injuries;
• fractures of ribs and vertebrae;
• spinal deformity;
• the occurrence of increased mobility of spinal motion segments.

In many cases, it is only possible to correct the consequences of inept manual therapy sessions through surgery. To avoid such consequences, you should contact only highly qualified specialists with extensive practical experience who are licensed to conduct such treatment.

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Briefly about osteochondrosis.

Many patients answer the question: “What’s bothering you?” they answer briefly: “I have osteochondrosis,” while treating their diagnosis as something ordinary and not serious: it’s the same for everyone. In fact, osteochondrosis is not just a change in bones and cartilage (as it is translated into Russian), it hides a whole set of syndromes, the so-called neurological manifestations of spinal osteochondrosis. And each person may have his own syndrome or even a complex of syndromes. The most common are muscular-tonic syndromes: stiffness in the neck, lower back, between the shoulder blades, in the shoulder girdle, in the buttocks, in the muscles of the thigh and shoulder, in the muscles surrounding the shoulder and hip joints. In addition, manifestations of osteochondrosis are vertebral artery syndrome, radiculopathy of various nerve roots, when the patient is bothered by lumbago and prolonged pain in the form of a stripe (previously it was called radiculitis), headache syndrome (cleverly sounds: cranialgia of vertebral origin), intercostal neuralgia, reflex cardialgia (heart Cardiologists have tested it inside and out: both during exercise and at rest, and with daily monitoring - the heart is healthy, but it still hurts, especially with nervous tension), functional blocks of the vertebrae (in this case, for example, there is a limitation in turning the head to the left or right, body in the lower back to the left or right, or there is an involuntary desire to bend your back back, “so that something clicks there,” or, conversely, bend forward and stretch the longitudinal muscles of the back). Osteochondrosis also includes intervertebral hernia (destruction of intervertebral discs). The elimination of these syndromes is what manual therapy does, except in the situation where the vertebrae are fused and an attempt to separate them will lead to a fracture of the vertebrae.

Video courses on massage

Independent study and application of basic techniques at home is excluded, otherwise there is a risk of seriously harming the patient through inept actions. Lessons and online courses are more useful for already practicing or beginning manual therapists who want to expand their arsenal of techniques and influence techniques, and get acquainted with the original methods of their colleagues.

The training program of Tamara Evgenievna Averina, which discusses the basic methods of manual correction of various parts of the body, is of great interest.

Let's give an example of some of them.

• We work on the thoracic spine: we place our hands so that the bone structures are between the thumbs, as in the photo. The pads should be located at the level of the seventh cervical vertebra. As you exhale, press and move your hand down. We repeat the movements along the entire length of the spine. Noise and crackling are a sign that the body is freeing itself from salt deposits.

• Starting from the lower back, we grab the skin above each spinous process with forceps and pull it back. This painful procedure is necessary: ​​the deposited salts literally solder the soft tissue to the spine. Particularly sensitive points indicate problems in the reflex organ.
• To work on the knee joint, we bend the patient’s leg toward the stomach, holding it by the knee with one hand and the shin with the other. We perform passive movements back and forth, in and out.
• We massage the abdominal area when the patient lies on his back with his legs bent. Using soft cat-like movements we push through the area of ​​the liver, gall bladder, pancreas and spleen. Vibrating penetration with lifting corrects the position of internal organs. A special breathing technique helps you relax: inhale deeply through your nose and exhale through pursed lips.

Professionally, without distracting information or self-promotion, the author of the method reveals the secrets of effective techniques that help restore the health of all systems and structures of the body.

Manual therapy and muscle-tonic syndromes.

Normally, muscle mass should be about 40% of body weight (for men a little more, for women a little less) and all this 40% is in constant tone (that is, ready to contract) and this 40% of body weight contains 40% of the volume blood that must circulate through the vessels. Try to stop the blood flow by squeezing your hand with a tourniquet. What will happen? Your hand will turn blue and it will hurt. The same thing happens with the back muscles (at any level). A sedentary lifestyle leads to prolonged static tension (muscles, like an additional pump, do not pump blood), constant stressful situations (constant combat readiness for unknown reasons) lead to an increase in muscle tone, like athletes at the start (but there is still no start, and this has been for years ). As a result, the muscles become denser, the speed of blood flow decreases, metabolic processes slow down (fresh nutrients do not reach the cells, and waste products do not leave), pain occurs, the muscles contract even more in response to pain, and a vicious circle results. In addition, with prolonged pain syndrome, working muscle tissue begins to be replaced by connective tissue, which turns the muscle into a ligament with the characteristics of a rope, not an elastic band. At the same time, the wall of the muscle cell becomes denser, the nutrition of the cell decreases, its aging and, ultimately, death occurs. And so on throughout the body. The picture is scary, but I can reassure you: this has been going on for years. Osteochondrosis is a disease from which one does not die quickly (unlike spasm of muscle fibers in the heart); with osteochondrosis one simply suffers for years, forgetting about ease of movement, good performance and good mood. Spasmed muscles simply “distort” the body. In the neck, muscles can fix the vertebrae and limit the head from turning in any direction, and displaced vertebrae can compress the vertebral artery and reduce blood flow to the head. In the thoracic spine, due to muscle spasm, inhalation is limited, and the person will always lack air. And if the intercostal nerves become pinched, there will be intercostal neuralgia (with intercostal pain) and even pain in the heart. When the lumbar muscles (the most powerful) spasm, the vertebrae simply move closer to each other like a jack. In this case, the intervertebral discs are flattened, squeezing out the disc core like toothpaste from a tube or jam from a pie (this is how intervertebral hernias are formed). Many patients tell me that they are active in sports and do not have a sedentary lifestyle. Sports are good. Actively working muscles pump additional blood, helping the heart. But at the same time, muscle tone increases and muscle mass grows. And actively working muscles eventually shorten and thicken anyway. The load on the tendons also increases, and in the tendons there are a lot of receptors that control muscle stretching, and when the tendons are overloaded, a protective mechanism is triggered, reducing the amplitude of movement. This is especially noticeable in the shoulder joints, when, for example, a woman cannot put her hand behind her back and unfasten her bra, and a man cannot quickly move his hand back before hitting a punching bag. You don’t want to train a muscle, but there is not a single muscle in the body that can stretch other muscles sufficiently. There must be an external force. Stretching muscles is precisely what manual therapy does. Moreover, during my sessions I always do a preparatory massage to warm up the muscles, relax them, and remove the “guard reflex.” No pain. If it hurts, the muscle protects itself and contracts, and if the patient weighs 120 kg (I had such people) then until he relaxes well, not a single doctor will help him. Many people believe that a chiropractor “straightens the vertebrae.” Try to “straighten” the vertebra that is held by the spasming muscle. At first it may “straighten up”, but the muscle will pull it back again. Muscle stretching is aimed not only at reducing peripheral resistance to blood flow, but also at reducing compression of the skeleton as a whole. In addition, with the help of certain types of manual therapy techniques, it is possible to dilate the blood vessels in the muscles and, as it were, additionally pump the muscles with blood (vascular therapy without vascular drugs).

Execution technique

The secret of the effectiveness of manual massage is the correct method of influence. It is selected taking into account the diagnosis and the results of the initial examination of the patient, during which the therapist pays attention to:

• mobility of the spine in different parts;
• the geometry of the shoulder girdle, hips, pelvic bones: their asymmetrical position indicates a possible problem;

• skin turgor condition: the formation of so-called Kibler folds is a sign of functional blockades of the spine;
• the degree of muscle tension and the presence of painful points in them.

As a result, the permissible amount of load and impact force for each patient is determined. The procedure itself is performed in several stages, following a strict algorithm of actions:

1. The session begins with muscle relaxation, using the technique of post-isometric relaxation - after inhaling, the patient holds his breath and tenses the muscles as much as possible. Exhalation is combined with stretching, thereby achieving complete relaxation of the problem area. As a result, the fibers become soft and elastic, allowing access to deep-lying bone structures.

2. If we are talking about moving joints, then they are mobilized: by rocking, stretching or holding the joint in the position of maximum extension, the doctor makes the structure work, normalizing the range of motion. This technique does not affect the ligaments, therefore it is considered gentle and forms the basis of “soft” therapy.
   Read also:  Spinal traction for hernia: what is it and how is it done?
3. When the preparatory work is completed, they begin the basic, sharp, precisely calibrated movements aimed at removing the blockage, correcting the position of organs or developing the mobility of the bone structure. They are performed in the direction of maximum limitation of mobility with complete relaxation of the patient’s body. As a rule, such manipulations are accompanied by a characteristic crunching or clicking sound, which is considered completely normal.

More gentle techniques practiced by chiropractors and massage therapists include traction - manipulations to stretch the spine, translations - effects along the axes of the joint, deflections, torsions, as well as blows and tapping of the vertebrae through applied fingers. They are used individually or in combination to diagnose or fix a problem. To learn more about the methods, watch the training video

Manual techniques can be used from the first days of life. Indications for the procedure are often the consequences of birth injuries: displacement of vertebrae, joints, bones, tendons, which negatively affect the well-being, behavior, development of the child and worsen with age. It is important to remember that all the tissues of a child’s body are soft and elastic, so it is better to entrust the child’s treatment to an osteopath who uses a gentle therapeutic technique.

Manual therapy and herniated discs.

Herniated intervertebral discs are a serious disease. This is the destruction of the m/n (intervertebral) discs. M/n hernias are manifested primarily by severe pain, body distortion due to severely spasmed muscles, and pain spreading in the form of a strip along the limbs (depending on which nerve is pinched by this hernia). At the same time, performance decreases sharply. The mechanism of formation of a disc hernia is as follows: heavy physical work (including weight training) or a strong and prolonged stressful situation leads to muscle strain, blood flow around the disc deteriorates, the disc begins to lose moisture, becomes flabby and begins to protrude beyond its boundaries. diameter of the vertebrae (I remind you that the m/n disc can be compared to a pie with jam, only round in shape). When the disc protrudes beyond the border of the vertebral body, it begins to put pressure on the longitudinal ligament of the spine (see the anatomy textbook), which holds the disc for some time. In this case, the patient’s back begins to ache after physical exertion, and the recovery period after exercise is lengthened. Then the longitudinal ligament gradually stretches and no longer holds the disc, and one day, for example, when carrying a heavy bag of groceries in one hand, the shell of the disc bursts and its core breaks out like jam into the cavity of the spinal canal. This may compress a nerve root (one or more) or the dura mater (the protective covering of the spinal cord). Sharp pain. Powerful muscle spasm with increased load on the spine. The patient cannot move calmly.

Previously, m/n hernias were treated only surgically (or the person constantly lived on painkillers). During the operation, the surgeon cuts the skin, muscles, vertebral arch (see anatomy textbook) and only after that removes the bulging disc. However, there is no guarantee that on the way to the hernia any spinal nerve will not be damaged or the hernia will actually be removed (I had several patients after surgery for m/n hernias in the lumbar spine with loss of sensation on the skin of the leg, with hypotrophy muscles (“shrunken leg”), with the presence of a herniated disc on repeated MRI images after surgery to remove this same hernia, i.e. cut - they cut, but cut - they didn’t cut). It should also be noted that after the operation a scar remains, which will interfere with repeated surgery on a hernia of a higher or lower vertebra (there can be several hernias). In our clinic, treatment of herniated discs is carried out comprehensively: by neurologists together with a chiropractor. With the help of manual therapy techniques against the background of vascular and analgesic therapy, axial unloading of the spine is carried out, relaxation of the spasmodic deep muscles of the spine, and the irritating effect of the hernial protrusion on the structures of the spinal canal is reduced. Treatment is not quick. But after several courses, the hernial protrusion of the m/n disc resolves like a lollipop. And this is confirmed by repeated MRI (magnetic resonance imaging) images.

Features of the effect on different parts of the spine

For each patient, the technique and nature of the impact are selected individually depending on the type and severity of the existing disorders. However, there are some general rules that chiropractors adhere to.

1. Before the start of any active treatment, relaxation is carried out to achieve the desired level of muscle relaxation and prepare them and the skin for subsequent procedures. It is also used at the final stage of the session.
2. Work with the spine begins with exposure to the thoracic region, then moves to the lumbar and only then to the cervical.
3. If it is necessary to correct deformities of the cervical or lumbar spine, preference is usually given to rotational techniques. At the same time, pressure techniques are more often used to improve the condition of the thoracic spine.
4. Working with the cervical spine requires a particularly highly qualified chiropractor, since it is he who is most susceptible to damage and injury of various kinds.

The duration of treatment depends on the severity of the existing disease. As a rule, in mild cases, 3-4 sessions are required to achieve noticeable results; in advanced situations, more than 15 procedures will be required.

Manual therapy and headache.

There can be several causes of headaches: from hereditary ones, such as migraine, to serious diseases such as a brain tumor. But most often headaches appear from “banal osteochondrosis.” The mechanism of its appearance depends on the functioning of the skull-neck system. Each independent bone element of this system must move, at least a little. It’s clear with the neck: all the vertebrae move relative to each other. But the skull is a bone, it shouldn’t hurt. But in fact, the skull is also movable. Or rather, its bones, which are connected to each other by sutures (see anatomy textbook). And in these sutures, movement of the skull bones is possible, similar to the flapping of a butterfly’s wings, only slow and low-amplitude. The skull seems to be breathing. Expands and contracts. On my own. In this case, intracerebral fluid (CSF) is pumped, which circulates in the space between the brain matter and the dura mater. Intracerebral fluid has many functions, but the main thing is that it must circulate at a sufficient speed and ultimately flow into the venous system and further along the systemic circulation. When movements in the sutures of the skull are blocked, the flow of cerebrospinal fluid slows down, toxins from biochemical reactions are poorly removed through the veins, and then there is a spasm of the neck muscles, which further reduces venous outflow. So much for your headache. Even the mechanism of migraine is due to the fact that the sharply dilated veins of the head, like a sponge, hold blood in them without movement. But the cells are alive. Biochemistry works according to a temperature of 36.6 degrees. Slags are formed. And they don't leave. And they give severe pain. In such a situation, manual therapy is aimed at moving the bones of the skull (using craniosacral therapy techniques), removing vertebral blockages and muscle spasms in the neck and, ultimately, starting the circulation of blood and intracerebral fluid. In addition to headaches, there may be pain in the suboccipital region, dizziness (the head “wraps around”), spots before the eyes or darkening in the eyes with a sudden change in the position of the head, even fainting. This is vertebral artery syndrome. In this case, it is not the outflow, but the flow of blood to the head that is disrupted. This can also be treated with manual therapy.

Methods

In manual therapy, there are 3 methods of influence: manipulative, craniosacral and visceral. The first is used most often and is based on working with the spine.

Craniosacral manual therapy involves influencing the bones of the skull and actively working on the vertebrae of the cervical spine. Thanks to her, she manages to:

• normalize intracranial pressure;
• improve blood supply to the brain;
• get rid of migraines;
• improve the quality of cognitive functions, i.e. attention, memory, etc.

Visceral therapy consists of a gentle effect on the internal organs of the abdominal cavity and the muscular corset. Targeted, precise actions of a specialist in the abdominal area lead to increased blood circulation and improved metabolic processes.

This ensures increased trophism of tissues and organs, which has a beneficial effect on the functioning of the heart, bronchi, lungs, gastrointestinal tract, kidneys and pelvic organs. As a result, the internal organs return to their normal position and gain natural mobility. The method is widely used not only for the correction of pathological conditions, but also to eliminate the consequences of past diseases, as well as to prevent the development of complications after injuries, surgical interventions, childbirth, etc.

All methods used in manipulative manual therapy can be divided into direct and indirect, passive and active, hard and soft. Each of them involves the use of special techniques, among which the most common are:

• manipulation;
• mobilization;
• post-isometric relaxation.

Particularly pronounced results with a gentle effect on the body are achieved by using the method of Russian academician Anatoly Grigorievich Gritsenko. He managed to form his own system of manual manipulation, which, in combination with the use of other well-known techniques, raised thousands of people to their feet and relieved pain of varying intensity.

Manipulation or push mobilization

Push mobilization is a widely used technique that involves a single, not too strong, but sharp push in the direction of the most pronounced restriction of movement. This technique is carried out at the moment of exhalation and the greatest relaxation of the body, which is usually observed when the patient does not expect any active actions. Thanks to push mobilization, the boundaries of joint mobility change, which leads to a significant increase in motor capabilities.

The correctness of the technique is eloquently indicated by a characteristic click. In this case, the functional block that limits mobility in this spinal motion segment is eliminated. After realignment of the vertebrae, the muscles relax, tension and pain caused by pathological changes are eliminated.

Although at first glance it may seem that the click or crunch is heard due to the bone element jumping into the desired place, in reality this is not entirely true. Its nature is still not known exactly, but the main version of its appearance is called the vacuum phenomenon, which implies the separation of previously tightly connected surfaces.

Mobilization

This is a technique of active influence on the spine, allowing:

• eliminate joint subluxations;
• return displaced vertebrae to normal position;
• reduce osteochondral protrusions called exostoses;
• eliminate increased muscle tone, spasms;
• significantly increase motor capabilities;
• activate the body's natural recovery processes.

It includes several types of techniques. Therefore, mobilization is distinguished:

• rhythmic;
• positional.

Rhythmic mobilization

This manual therapy technique is quite painful, but very effective. It is easy to implement for a specialist and facilitates the rapid elimination of functional blocks.

The essence of rhythmic mobilization is to perform traction of the spine followed by rotation (turning) of its rhythmic oscillatory movements. That is, initially the chiropractor stretches the joints without excessive effort, which helps to increase the distance between individual vertebrae.

Then he shifts the desired vertebrae to the sides relative to each other and smoothly swings them in the direction of restricting mobility. The technique is performed rhythmically with an intensity of 1–2 movements every second.

If the use of rotational movements is impossible, for example, in the sacral area, rhythmic pressure is applied to the desired areas. This compression effect is also used in the first sessions of manual therapy, when the muscles still maintain high tone.

Positional mobilization

This method of manual therapy can be called universal. It combines elements of rhythmic mobilization, PIR and manipulation. It involves a gentle impact at a slow pace.

Initially, the chiropractor finds the position in which the greatest tension is observed in the joints, and holds the patient in it with slight force for 1-2 minutes. Additionally, the flexor muscles are stretched and the extensor muscles are contracted, which leads to the correct distribution of the load on them while maintaining an upright body position.

Postisometric relaxation

The post-isometric relaxation method or PIR is one of the soft impact techniques. It promotes:

• pain relief;
• achieving maximum relaxation and stretching of the muscles in the spine;
• increasing the elasticity of muscle fibers.

This allows you to prepare the body for active exposure or relax after it. All movements are performed carefully and gently while inhaling. In this case, the patient needs to strongly tense the muscles. After a few seconds, they will reflexively relax, at which time the chiropractor, holding the patient’s body with one hand, makes pressing movements in the desired direction with the other. Returning to the starting position is carried out while exhaling. This causes muscle stretching and complete relaxation.

The procedure is repeated 7–10 times. This is enough for the muscles to relax, become soft and allow the specialist to perform the necessary manipulations at a deeper level, including the spine.

PIR techniques can be used on any part of the spine, but differ in different techniques.

Method of A. G. Gritsenko

A. G. Gritsenko’s method has been practiced for more than 27 years, but it takes more than one year to fully master it. Therefore, unfortunately, there are still quite a few specialists who successfully practice it.

It is based on restoring the body's reserve capabilities through the spine. The human body has the ability to recover when a negative factor is eliminated, which is usually the displacement of the vertebrae relative to the normal axis of varying degrees of severity.

Against the background of various factors, among which the leading positions are occupied by a sedentary lifestyle, heavy lifting and genetic predisposition, nerve fibers are pinched by displaced vertebrae. This leads to disruption of the functions of the spinal cord, which innervates organs, endocrine glands, muscles, skin, etc. Therefore, when it or the nerve roots extending from it are pinched, the connection between the organ and the nervous system is disrupted. This leads to a decrease in their functionality, since the organ stops receiving commands, which becomes a fundamental impetus for the occurrence of pathological changes in it.

Gritsenko’s method is based specifically on normalizing the position of the vertebrae, eliminating spinal deformation, which allows the release of pinched nerves and eliminate pressure on the spinal cord. It leads to:

• normalization of the spinal cord;
• restoration of nerve conduction;
• elimination of pain syndrome.

A. G. Gritsenko’s method has 95 patents and is unique. It involves carrying out ultra-precise, targeted, one might say, jewelry-like effects on each vertebra of the spinal column, which leads to the restoration of their normal axial position and the elimination of pathological processes in the body.

Treatment using the method of A. G. Gritsenko can be combined with work of any kind and business trips. Each session lasts from 10 minutes to half an hour, which depends only on the patient’s condition. As a result, there is often no need for surgery and continued expensive drug therapy.

Manual therapy and the postpartum condition of women.

Everything is simple here. During pregnancy, the fetus grows and becomes heavier, the load on the back increases, it becomes more difficult for the back muscles to maintain a vertical position (just as it is difficult to hold an iron at arm's length), the leg muscles become involved, which also become overstrained and begin to ache. In addition, a pregnant woman experiences a powerful hormonal shift, which in mechanical terms is aimed at preparing for childbirth in the form of loosening the cartilage tissue (so that the pelvic bones diverge better). And cartilage tissue is not only in the pelvic joints, but also in the intervertebral discs, which also soften. And modern women are less mechanically strong than our grandmothers (due to lack of proper physical training since childhood). And the picture that appears is similar to that when a weight was placed on the dough: the load is downward, and the body “spreads” in all directions. And then childbirth. And then the extra weight. And then the child is in her arms (and every month he gets heavier and heavier). And then everything hurts because everything was overstretched. And everything is also infuriating (and this is additional overvoltage). Of course, manual therapy will not change hormonal levels and will not remove excess fat deposits. But on the other hand, a chiropractor can relieve the load on the spine, work out tired and spasmodic muscles (and some especially painful muscle bundles, which physical education cannot do), improve the nutrition of weakened intervertebral discs (let me remind you: the intervertebral discs of an adult do not have their own vessels that directly deliver nutrition to discs, it occurs diffusely from the surrounding muscles). Maybe manual therapy is not always a quick treatment, but it has an important advantage: it is an “environmentally friendly method”, i.e. without chemical effects on the body. And various medications are often contraindicated for breastfeeding women.

Contraindications

When contacting a qualified specialist who is thoroughly familiar with modern methods of manual therapy, sessions cannot have any negative effect on the body, but only if there are no contraindications. These include:

• oncological diseases;
• fresh injuries;
• severe exacerbation of a chronic disease;
• acute infectious process in the body;
• serious damage to the central nervous system;
• severe form of arterial hypertension;
• recent stroke or heart attack.

Manual therapy and the cardiovascular system.

The heart is a pump. The body is a system of pipes. The pump ages and wears out over time. Compression in the working chambers decreases. The body thickens and floats with fat, squeezing the vessels (“pipe system”). In addition, these “pipes” become clogged from the inside (cholesterol plaques are deposited). Peripheral resistance to blood flow increases, it slows down, the blood is poorly saturated with oxygen and poorly nourishes the tissues, and the heart is simply strained from hard work. Manual therapy reduces peripheral resistance to blood flow, dilates blood vessels, helps additional vessels (collaterals) work, and facilitates the work of the heart. Life expectancy is increasing.

Thus, modern manual therapy has ceased to be reduced to a narrowly focused process of “vertebral realignment” with a large percentage of complications in the form of fractures and dislocations. Today it is a safe, painless, “environmentally friendly” method of treatment. Which can be used either independently or in combination with treatment from other specialists: from a neurologist and cardiologist to a psychotherapist.

This article provides only basic examples of the use of manual therapy related to the spine and back in general. Manual therapy is much broader. If you have any questions for the chiropractor, you can ask them through the administrators of the Preobrazhenskaya Clinic by phone. 385-70-07.

Treatment results

If you contact a chiropractor when the first symptoms of the disease appear, it is often possible to completely solve the existing problem with the spine without resorting to the help of neurosurgeons.

At the same time, the effect on the spine has a beneficial effect on the entire body. Therefore, after eliminating postural defects, which are present to a greater or lesser extent in more than 90% of people, as well as functional blocks:

• muscles relax;
• pinched nerves and blood vessels are released;
• motor activity increases;
• Nervous tension is eliminated;
• internal organs occupy the position initially assigned to them by nature, blood circulation improves in them, and pressure from neighboring anatomical structures is eliminated.

In such situations, improvement can be achieved either only through a course of manual therapy or by supplementing it with treatment prescribed by a specialist. Often this allows you to completely get rid of the disease or at least significantly improve the patient’s condition.

Thus, manual therapy allows you to cure or achieve long-term remission in diseases such as:

• chronic diseases of the lungs and bronchi, including bronchitis, bronchial asthma, frequent pneumonia;
• pathologies of the gastrointestinal tract, including colitis;
• prostatitis;
• uterine fibroids;
• female and male infertility;
• nephroptosis;
• vegetative-vascular dystonia.

In all cases, thanks to manual therapy, the body's resistance to infections increases, the intensity of metabolic processes increases, which helps to increase energy, efficiency, even slow down the aging process and naturally increase life expectancy.

Treatment approaches

Before starting such treatment, it is imperative to diagnose the affected structures. Only after examination, clarification of complaints, X-rays, or MRI, sometimes ultrasound, can one see the presence of indications, the features of the course and the complexity of the process. This is why a true specialist will never work in isolation from a medical facility.

It is impossible to heal in one session. On the contrary, in most cases, after the first procedures, patients often feel a significant deterioration in their health, an exacerbation of the process. This is a normal reaction that goes away within a couple of days.

The main task of any doctor is to do no harm. Therefore, the specialist categorically avoids excessive, aggressive and dangerous influences. It has been proven that the maximum positive effect comes from a soft, osteopathic effect. The doctor works especially carefully with children and the elderly. Whatever the method, the patient is always fully monitored, and any changes in well-being are taken into account.

Reception features

At the initial consultation, the doctor necessarily collects a brief medical history, manually diagnoses the patient, determining the degree of joint mobility, areas of maximum tension and pain. Pain activity is assessed. The specialist needs to decide on further therapy tactics and a program for subsequent sessions. In the presence of severe, complicated illnesses, a number of additional diagnostic tests are required. Often, patients can be sent for X-rays, MRIs, and, if indicated, ultrasound or EEG.

What to do if you have back problems?

If symptoms of osteochondrosis appear, then at the first stage it is necessary to be examined by a qualified specialist. This is necessary to determine neurological and orthopedic disorders, order the necessary studies for correct diagnosis and determine treatment tactics. An incorrect diagnosis can sometimes lead to very serious complications!

Most patients understand perfectly well that they will be treated not by the name of the technique or the name of the medical institution, but by an ordinary practicing doctor. The real result of treatment depends on his professional qualities. Hand healing usually requires experience and care. In some cases there are contraindications that need to be recognized and properly assessed.

In connection with the above, it is important to clearly understand that only a certified doctor who has undergone special training and has the appropriate certificate has the right to carry out such treatment.

Where does the specialist meet?

Often, chiropractors work in diagnostic and treatment centers of both general and specialized focus. They are often accepted in private clinics and spine treatment centers. In any case, you can get an appointment with such a specialist only by prior appointment.

The only significant difference is the number of people and the pricing policy. Everyone chooses for themselves: an acceptable price within the hospital walls or a more expensive appointment by appointment, but in comfortable conditions. The entire complex of examination, testing and therapy remains unchanged. This is in no way dependent on the reception location.

You can also find a doctor using the Internet. Online consultation is indeed less reliable, but it is accessible and very convenient. This is an opportunity to ask questions, describe the clinical picture of the disease, receive specialized answers, and, if necessary, make an appointment.

Why is it important to normalize the functioning of the spine?

Manual correction of the spine allows you to eliminate not just the symptoms, but also the causes that contribute to the premature destruction of the intervertebral discs. Osteochondrosis, protrusion and disc herniation are formed in cases where the load on the vertebral motor segments is distributed unevenly, both during movement and when maintaining posture. Those disks that are subjected to constant overload sooner or later cannot stand it and begin to collapse. First, small cracks form in the fibrous ring of the intervertebral disc, then protrusions, and then hernias.

To prevent back pain, the spine must work correctly!

Troubleshooting the spine is the most important element, both for the prevention and treatment of osteochondrosis, hernias and protrusions of intervertebral discs, as they eliminate the causes of their occurrence. Only when the function of the spinal column is normalized is normal blood supply and venous outflow in the problem area restored. Tablets, injections, ointments, and physiotherapy are not able to release pinched nerve fibers and blood vessels and make the spine work as it should. In this regard, the answer to the question becomes quite clear: “Why do manual therapy in general and why, in case of osteochondrosis, hernia and protrusion of the intervertebral disc, does it allow to increase the effectiveness of treatment in general?”

How many sessions are needed for a course of treatment?

The course of treatment requires an average of five to ten sessions. The recommended frequency of conducting them is once every six months, but there may be various individual options. After completing the course of treatment, the doctor usually gives several exercises of therapeutic exercises to consolidate and maintain the achieved result or refers to a physical therapy doctor.

How is an appointment and diagnosis with a chiropractor?

At the appointment, the doctor asks several questions regarding complaints, the course of the disease, the nature of the symptoms, the frequency of their manifestation, etc. A visual examination is carried out using the hands (palpation). The doctor palpates the spine, determines areas of deformation, muscle tone, and areas of increased tension. In this case, the doctor may ask the patient to take one or another position, bend over, turn, etc.

The main diagnostic methods of manual therapy are described in the table.

diagnostic method	description
palpation	feeling muscles, skin surface, joints with hands, determining the degree of pain, increased tone, functional disorders
push palpation	examination of joints using rhythmic, energetic thrusts
joint examination	assessment of joint movements, painful condition, dysfunction, specific phenomena, degree of blockade
stretching	studying the degree of extensibility of the paired muscle in comparison with its healthy counterpart on the other side

Along with these methods, instrumental diagnostic methods are also used:

• performing x-rays;
• MRI;
• electromyography;
• CT;
• TANK;
• HOW.

For additional consultation, you may need to see a neurologist, orthopedist or other specialists.

Features of follow-up and doctor’s recommendations

A specialist may recommend changing your physical activity and type of diet. It is also important to consider that:

• After the session, you should not get up suddenly; it is better to do it slowly.
• Within 24 hours after the procedure, you should avoid heavy lifting and avoid sports.
• After the session, hypothermia and overheating (drafts, hot bath) are unacceptable. The first can lead to spasm in areas of intense impact, the second can lead to swelling.

The doctors of our Clinic will never refuse you further consultations. They will recommend a follow-up date after treatment to assess effectiveness.