Issue link: https://www.massageandbodyworkdigital.com/i/78617
OVER-MANIPULATION SYNDROME problem is known as over-manipulation syndrome (OMS), and for simplicity, I will focus on the syndrome as applied to the cervical spine. A client with OMS usually comes into my office with severe neck pain and a feeling of This relief might have lasted for some time, but eventually the client would repeat the process over and over, like a lab rat with a food lever. stiffness combined with an obsession and compulsion to wrench his neck around in an effort to get it to pop. Previously, he might have made family members cringe with how loud he could make his neck crack, but he's come to my office asking for relief in any form, as he recently found he can no longer elicit any "snap, crackle, or pop" from his spine on his own. In my years as a chiropractor, I have seen hundreds of these people. They usually start years earlier after discovering that they could stretch their head to the side to get a "pop" out of their neck, and immediately any muscle tension and joint pain would disappear. This relief might have lasted for some time, but eventually this person would repeat the process over and over, like a lab rat with a food lever. Over time, an addiction sets in, and instead of self-adjusting at a frequency of once a week or once a month, it becomes a once- a-day, or more, compulsion. The period of relief also lasts for less and less time, so they become accustomed to adding increased force and rotational torque to try to get the same level of joint release. Chiropractic work utilizes high-velocity (speed of the mobilization) and low-amplitude (how deep the force is applied) manipulative procedures. If done correctly through the joint plane (line of drive), then there is less force necessary to make the release. Also, chiropractors may utilize moist heat, muscle stretching, massage, and other soft-tissue release procedures prior to the manipulation to relax the resisting musculature. When a client self-manipulates, however, there is no line of drive through the joint plane and usually no warming or relaxation of the musculature; therefore, there is the addition of more force, more rotational torque, more neck hyperextension, and a higher amplitude—all of which mean trouble. Over time, the increased force produces inflammation and spasm of the muscles and muscle insertion of the neck's stabilizing muscles, and you may also get laxity of the supporting ligaments of the spine. Research has shown that noxious stimulation of the back muscles, interspinal ligaments, dura mater, and zygapophyses joints can produce local and referred pain. The primary symptoms are constant muscular pain and the feelings of spinal joint tension and pain. The client usually says he just feels like he needs a good crack in the neck. The pain manifests as sharp, bilateral pain and stiffness with a deep, aching pain around the spine. There is usually no loss of active or passive spinal motion, but there is pain associated with movement and lots of subjective complaints of stiffness. Passive movement may produce pain at end range. Palpation usually reveals moderate to severe tenderness and hypertonicity laterally at the scalene insertions, as well as at the insertion of the levator scapulae, trapezius, splenius capitis, and splenius cervicis. There may also be a radiation of pain into the suboccipital region or to the upper extremities in a non-dermatomal distribution. Muscle weakness and other neurological signs such as reflex deficit and sensory loss are not present. I tell the client his body is trying to splint the area. Like putting on a cast for a broken bone, the body is 94 massage & bodywork september/october 2012 The