Mobilisation
Injury type: Acute/ Chronic
Category: Allied Health Options
Rating: Promising
What is it?
Mobilisation is defined as low-grade/velocity, small or large amplitude passive movement techniques or ‘neuro-muscular’ technique within the patient’s range of neck motion and control. They are gentle, controlled movements of the joints affected and differ from manipulation, with the aim of increasing movement and relieving pain. They are used by physiotherapists to treat joints that have become stiff from lack of movement, and/or are causing pain, such as neck pain resulting from stiff/inflamed joints of the cervical spine.
How does it work?
Spinal mobilisation is thought to work by improving mobility in areas of the spine that are restricted. Such restriction may be found in joints, connective tissues or muscles. Mobilisation may remove or reduce the restriction, thereby removing the source of pain and providing symptomatic relief. Restoration of spinal mobility, both in physiological movement and in spinal segmental mobility, often results in a reduction in a patient's pain and muscle spasm. There is also a theory that mobilisation can reduce pain by moving swelling containing neurotransmitters such as substance P and histamine. In addition, the threshold which stimulates pain nerves may be increased by the gentle oscillations, therefore making it less likely that pain will be detected
Is it effective?
Two reviews synthesising evidence from primary research studies and relevant clinical practice guidelines have identified consistent recommendations in relation to the use of mobilisation for whiplash. One review1 recommended that passive joint mobilisation can be considered for the management of whiplash, as evidenced across multiple clinical practice guidelines. The other systematic review2 concluded that mobilisation is ‘likely helpful/ worth considering’ for recent grades I-II whiplash.
While mobilisation appears beneficial for whiplash on its own, evidence also suggests that the intervention is effective when used as part of a multimodal approach. This is supported by a systematic review which included two whiplash related clinical practice guidelines1 and findings from an updated systematic review3. The updated systematic review3 identified moderate level of evidence for a multimodal intervention, which consists of manual mobilisation and exercise for acute whiplash, and a weak level of evidence on the similar approach for chronic whiplash
Are there any disadvantages?
Literature reported benign, transient side effects (related to either/both mobilisation and manipulation) such as headache, radicular pain, thoracic pain, increased neck pain, distal paraesthesia, dizziness, and ear symptoms. Serious side effects were not reported, however, mobilisation is generally regarded as being safe. You may experience some discomfort/soreness during the treatment and over the following day or so, however this should not be severe and should settle quickly.
Where do you get it?
Spinal mobilisation is commonly provided by physiotherapists, and other health professionals such as chiropractors and osteopaths. Treatment should be provided by a qualified professional.
Recommendations
Spinal mobilisation may be useful as an isolated treatment or adjunct to other treatments (i.e. in a multimodal care approach). More high quality research is needed, especially for chronic whiplash.