Brief overview
- Treatment: range of motion exercises, analgesics, manipulation or mobilization using manual therapy methods.
- Symptoms: Depending on the affected region, pain during movement, radiating to the head, abdomen and chest, for example; depending on the region, headaches, nausea; correlations not conclusively clarified scientifically
- Causes and risk factors: Vertebral blockage not yet scientifically proven, possibly pain stimuli, for example due to incorrect loading from the vertebral joints, cause persistent cramping of the musculature
- Diagnosis: Based on symptoms, physical examination; imaging procedures such as X-ray or magnetic resonance imaging to exclude herniated disc or tumors.
- Prognosis:Often vertebral blockages resolve on their own; various methods help well; serious causes such as herniated discs or tumors must be ruled out
- Prevention: Back-healthy behavior such as certain carrying techniques, lifting heavy loads from the knees, regular exercise, compensating for movement during sedentary activities
What is a vertebral blockage?
Other names for joint blockage are segmental dysfunction and reversible hypomobile articular dysfunction: “reversible” means temporary, “hypomobile” means restricted mobility, “articular” is derived from the Latin word for joint (articulatio), and “dysfunction” means malfunction.
Vertebral blockage occurs in various sections of the spine – the cervical spine (cervical spine blockage), thoracic spine (thoracic spine blockage) or lumbar spine (lumbar spine blockage). A special case is the blockage of the sacroiliac joint (sacroiliac joint, ISG).
The concept is based on the assumption that vertebral blockades occur more often, are mainly harmless and in many cases disappear on their own.
The concept of vertebral block is controversial and not scientifically supported by the methods of evidence-based medicine.
How can a vertebral blockade be resolved?
If necessary, the practitioner relieves the pain of a vertebral blockage by means of pain medication. This also helps to relax the muscles – as does, for example, an application of heat or muscle relaxants (muscle relaxants).
Solving vertebral blockages by means of manual therapy
Manual medicine (chiropractic) basically recommends two therapeutic techniques for a vertebral blockage – mobilization and manipulation:
In mobilization, the therapist or physician performs repeated slow movements of the joint in the restricted direction of motion, in the form of traction (longitudinal traction) and/or sliding motion. In this way, the restricted range of motion should be gradually extended.
During manipulation, a short, fast, targeted movement impulse in the “free” (i.e., not the painfully restricted) direction of movement should release the vertebral blockage. Sometimes a cracking sound can be heard. Manipulation may only be performed by a specially trained physician. In certain situations it is not allowed (contraindicated), for example in inflammatory processes, severe osteoporosis or psychological disorders.
Blockages can be removed independently with various exercises in the sense of manual medicine. However, the exercises for this should be taught by an experienced medical professional.
The methods of manual medicine (chiropractic) belong to the field of alternative or complementary medicine. It is intended to heal disorders of the musculoskeletal system in particular by means of exclusively manual methods, i.e. methods practiced “with the hand”. In doing so, chirotherapy draws on methods of osteopathy and chiropractic. Corresponding training courses are recognized by the state medical associations, and trained physicians are allowed to use the additional title of manual therapy or chiropractic after passing an examination. However, the methods of manual medicine are controversial from a scientific-scholarly medical point of view and are not considered evidence-based medicine.
What are the symptoms?
A thoracic vertebral block often also causes local pain that sometimes radiates (for example, to the abdomen). The pain of such a blockage of the thoracic spine is often movement- or respiration-dependent. Symptoms such as nausea, difficulty breathing or chest pain are also associated with it.
A blockage in the lumbar spine (lumbar spine blockage) is also manifested in many cases by sudden pain. Sometimes these occur acutely during a movement (“lumbago”). In some cases, they radiate into the legs.
Due to the pain caused by the blockage, patients often adopt a forced posture (relieving posture), which in turn usually results in painful strain and tension in the long term.
Many patients report that vertebral blockages occur again and again.
Causes and risk factors
The mechanism of vertebral blockages has not yet been conclusively proven scientifically and is based more on empirical values.
In the past, a mechanical catching of the so-called facet joints in the vertebrae was assumed to be the basis of vertebral blockage.
Today, it is assumed that a pain stimulus is triggered by these nerves, for example by jerky movements or constant incorrect loading. As a result of this pain stimulus, the attaching muscles tense reflexively. According to newer theories, this muscle spasm forms the vertebral blockage and not, as previously assumed, a catching of the vertebral joints.
Experts assume that a vertebral blockage also has the following causes:
- Pathological changes in the joint surfaces, for example due to overloading, trauma, inflammation, lack of exercise or metabolic disorders
- Tension or shortening of the musculature associated with the joint
- Painful stimuli (nociceptive afferents) in the case of acute or repeated incorrect loads
- Painful stimuli from internal organs, which lead to painful muscle hardening (hard tension)
In terms of a psychosomatic interaction, therapists discuss whether psychological problems sometimes manifest themselves physically, for example in vertebral blockages.
Examinations and diagnosis
If you feel that a vertebra (such as a thoracic vertebra) is blocked, first see your family doctor. If necessary, he or she will refer you to a specialist (such as an orthopedist).
This anamnesis discussion is followed by a physical examination. During this examination, the doctor checks the mobility of the spine in various sections.
Imaging procedures (such as X-rays or magnetic resonance imaging, MRI) are primarily used to rule out other possible causes of back pain, such as injuries, inflammations or tumors. Herniated discs or inflammatory processes such as facet syndrome are also expressly not vertebral blockages. The physician examines accordingly in this direction as well.
Course of the disease and prognosis
With the help of manual treatment, a blockage in the back can be released. Sometimes, however, this is not even necessary, because a vertebral blockage often resolves itself spontaneously after a few hours or days.
Prevention
The concept of vertebral blockage is not fully understood. However, experience has shown that so-called back-healthy behavior helps to prevent not only vertebral blockages but also other impairments of the musculoskeletal system. This includes, for example, certain techniques for lifting heavy loads properly, regular exercise such as sports, and breaks from sedentary activities.