Joint tension is a bio-mechanical alteration that may involves the abnormal movement and/or position of a joint in one or more planes. Essentially this is a functional entity which can lead to sensitisation of the nervous system and a perception of pain (see functional neurology). Joint tension can also start a process of degenerative changes (see osteoarthritis).

Joint tension is an abnormal movement (function) which can be corrected using chiropractic manipulation or other techniques [79-87]. There is often but not necessarily, a structural (static) displacement of a vertebra and neurological and vascular involvement [88].

Diagnosis

Chiropractors determine the presence of joint tension by checking for abnormal alterations in the movement of a joint. Movement is often limited between individual joints in the spine or in the global movement of the spine. There is often a poor correlation between presenting symptoms and objective physical signs. There is an absence of “red flags” in the medical history, positive neurological signs and radiographic signs.

Evidence based summary for manual therapy [53]

Randomised controlled research trials (RCT) and reviews (the highest current standards of scientific evidence) suggests that there is high quality evidence (on a scale of inconclusive, moderate and high) that spinal manipulation/mobilization is an effective treatment option for subacute and chronic LBP in adults [63,64,65]. There is moderate quality evidence that spinal manipulation/mobilization is an effective treatment option for subacute and chronic LBP in older adults [69]. There is also moderate quality evidence that spinal manipulation/mobilization is an effective treatment option for acute LBP in adults [63,67]. It has been found that for massage there is moderate quality evidence that it is an effective treatment for subacute and chronic LBP in adults [66,68].

Other effective non-invasive physical treatments or patient education [53]

Advice to stay active, interdisciplinary rehabilitation, exercise therapy [70,71], acupuncture, yoga, cognitive-behavioral therapy, or progressive relaxation for chronic LBP and superficial heat for acute LBP [63,66].

Back-in-Action clinical comment

Chiropractic assessment and treatment of simple low back pain is aimed at finding and reducing tension and the causes of tension in the joints and muscles. We find much of the discomfort associated with simple low back pain arises from joint dysfunction (tension) or injury through too much movement (sprain). The joints most often involved are in the lumbar spine or the sacroiliac joints. Chiropractors usually like to address why there is an increase in stress in this area.

In our experience treating the symptoms and underlying causes of simple low back pain benefits from a combination of treatment techniques to increase the probability of a good result. Our approach often incorporates spinal manipulation, mobilisation, muscle release techniques, cranial work, back exercises (individually tailored self mobilisation, stretching and strengthening), referral for massage therapy, diet and nutritional advice, functional neurological exercises, breathing techniques, acupuncture, cryotherapy (heat and/or ice), postural improvements, foot orthotics, ergonomic advice and relaxation counselling.