The Case for Utilizing Prolotherapy as a Promising Stand-Alone or Adjunctive Treatment for Over-Manipulation Syndrome

Gordin K, Ross Hauser, MD The case for utilizing prolotherapy as a promising stand-alone or adjunctive treatment for over-manipulation syndrome. The Journal of Applied Research. 2013;13(1).


Objective: The medical term ‘manipulation’ may refer to any passive movement. Primarily the term refers to a sudden thrust of small amplitude, performed at a rapid speed accompanied by an audible crack. This manual procedure, also known as ‘Grade V Mobilization,’ ‘adjustment,’ and ‘spinal manipulation therapy (SMT)’ is used extensively in the chiropractic and osteopathic professions, and is steadily gaining popularity with physiotherapists, medical practitioners, and podiatrists. With growing popularity comes the responsibility to analyze long-term therapeutic and physiologic effects of joint manipulation and the corollary risk Over-Manipulation Syndrome (OMS). As used in this text, OMS is defined as a musculoskeletal condition characterized by a constellation of symptoms ranging from chronic pain to muscle spasms due to ligament laxity and joint instability, induced by manipulation performed by practitioner, and/or self-manipulation.

Design: This literary synthesis critically analyzes long-term effects of high-velocity, lowamplitude thrust manipulation on connective tissue stability/mobility, and presents a basis for alternative approaches designed to minimize complications. Through a comprehensive cross-examination of research study results, this review investigates the long-term effects of spinal manipulation, and initiates a discussion about the research methodologies and relevant findings related to the therapy.

Method: The review process involved compiling scientific publications and searching indexed biomechanical and medical studies relating to SMT treatment techniques, measurements of mechanical and safety parameters, and manipulable lesions. Relevance to spinal manipulation was the primary criterion for selecting articles for inclusion in the review. Original reports, surveys, case studies, Meta analyses, and relevant content in any of the subfields of spinal manipulation were selected, irrelevant of date of publication.

Conclusion: Currently there are numerous accepted manual procedures but no singular biomechanical parameter to predict which procedure type is most effective and safe, and which manual treatment offers the greatest likelihood of long-term recovery. While hypotheses and classification systems are continuously investigated, the current level of safety remains ambiguous; as such, alternative therapies like Prolotherapy, which may counteract potential risks, are useful.

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