From the Guidelines
Thoracolumbar junction manipulation is a recommended treatment option for patients with low back pain or thoracic pain, as it can help restore normal joint mobility, reduce pain, and improve function, as supported by the American College of Physicians and the American Pain Society guidelines 1.
Key Points to Consider
- The procedure involves a high-velocity, low-amplitude thrust to the specific spinal segment, typically performed with the patient lying on their side.
- A thorough assessment is necessary to ensure patients have no contraindications, such as fractures, tumors, severe osteoporosis, or spinal instability.
- The manipulation works by stimulating mechanoreceptors, reducing muscle guarding, and restoring normal biomechanics to the area.
- Patients may experience immediate relief, though some soreness at the treatment site is normal for 24-48 hours.
- This technique is typically part of a comprehensive treatment approach that may include exercises, stretching, and other manual therapies to achieve optimal outcomes.
Important Considerations
- Spinal manipulation, including thoracolumbar junction manipulation, is a manual therapy technique that applies loads to the spine using short- or long-lever methods and high-velocity thrusts to a spinal joint beyond its restricted range of movement 1.
- The American College of Physicians and the American Pain Society guidelines recommend spinal manipulation as a treatment option for low back pain, as it can provide symptomatic relief and improve function 1.
- Patients should be thoroughly assessed before receiving this treatment to ensure they have no contraindications, and the manipulation should be performed by a trained healthcare professional.
From the Research
Thoracolumbar Junction Manipulation
- The thoracolumbar junction syndrome, also known as Maigne's syndrome, is a cause of low back pain that can be treated with a global physiotherapy approach, such as the Mézières method, to reduce pain and improve posture and mobility 2.
- Joint mobilization and exercise directed at the thoracolumbar junction can lead to marked improvements in pain, thoracic range of motion, and functional deficits in patients with hip and groin pain 3.
- Manual therapy procedures that address facet restriction and soft tissue dysfunction in the thoracolumbar junction can provide relief in symptoms and improve functional ability in patients with low back pain and radiating pain into the gluteal area 4.
Treatment Options
- Nonoperative treatment of thoracolumbar burst fractures without neurologic deficit can be as effective as operative treatment in terms of pain and function, with fewer complications and lower costs 5.
- Conservative treatment can be a viable option for thoracolumbar burst fractures without neurological deficit, with results equal to those of surgery and fewer complications 6.
- Surgery may be necessary in certain cases, such as patients with polytrauma or deteriorating neurology, or in cases of inherently unstable injuries like fracture dislocations, chance fractures, and flexion rotation injuries 6.
Key Findings
- The thoracolumbar junction is a potential source of symptoms in patients with hip and groin pain, and treatment strategies directed at the thoracolumbar junction can be effective in reducing pain and improving function 3.
- A global physiotherapy approach, such as the Mézières method, can be effective in reducing pain and improving posture and mobility in patients with thoracolumbar junction syndrome 2.
- Manual therapy procedures that address the thoracolumbar junction can provide relief in symptoms and improve functional ability in patients with low back pain and radiating pain into the gluteal area 4.