Are you confused by the terms "manual therapy," "soft tissue mobilization," or "spinal manipulative therapy?" Doctors Swenson and Haldeman have taken the time in this report to define and describe each one of these treatments. They also looked at the research on spinal manipulative therapy (SMT). SMT is divided into three types of treatment offered by a chiropractor, osteopath or other medical doctor, or physiotherapist.

Massage, mobilization, and manipulation (adjustments) make up the three broad groups of SMT. Massage is applied to the soft tissues around the spine. No joint motion occurs. Deep tissue massage, acupressure, muscle stimulation, and relaxation methods are all part of massage.

Mobilization stretches or puts pressure on the spine. This is done within the joints' active range of motion. The joints, ligaments, and muscles are moved slowly. A regular rate of rhythm is usually used. Massage and mobilization help get the patient ready for manipulation.

Manipulation puts a sudden and quick force on one or more joints. There are several different types of manipulations. The type depends on where the force is applied and what position the patient is in.

The authors of this study review the theory for and uses of SMT. They conclude that studies show SMT is a common and safe therapy for low back pain. It's best used with new episodes of low back pain. Consumer demand for SMT has made it a part of standard medical treatment in many areas of the United States. Medicare, HMO plans, and most health insurance now cover SMT in their plans.

Rand Swenson, DC, MD, PhD, and Scott Haldeman, DC, MD, PhD, FRCPC. Spinal Manipulative Therapy for Low Back Pain. In Journal of the American Academy of Orthopaedic Surgeons. July/August 2003. Vol. 11. No. 4. Pp. 228-237.