Chiropractic Manipulation

Chiropractic manipulation

Dr. Lane Bunker and Dr. Bob Sundquist utilize evidence-based Chiropractic manipulation / treatment procedures, integrating the best available relevant research with individual clinical expertise and judgment, to achieve the best possible clinical outcomes. Applying clinical evidence-based treatments results in outcomes that are safer, more efficacious, more accurate and more powerful.

Dr. Bunker and Dr. Sundquist are Level 1 Accredited Providers with the Colorado Division of Workers’ Compensation, and provide treatment as recommended by the Medical Treatment Guidelines, to improve physiologic function, improve biomechanical joint dysfunction and decrease pain.

Dr. Bunker and Dr. Sundquist provide spinal and extremity manipulation, with specific manually guided high velocity, low amplitude (HVLA) force. The physiologic benefits from joint manipulation are comprised for major areas: restoration of normalized movement, relief from pain, normalization of muscle hyperactivity and reflex effects.


Recent trends in treatment of back and neck pain emphasize the principles of early mobilization and rehabilitation to restore function. Time can no longer be considered the healer, because stiffness and predisposition to injury are very real consequences of failure to intervene therapeutically and often necessitate more exhaustive care later.

There is evidence to suggest that the pharmacological relief of pain may not be the optimal treatment of choice in back and neck pain management, but rather that the restoration of motion may be an alternative goal. Relief of pain with medication has not been shown to enhance the healing of spinal tissues. On the contrary, an individual who was rendered pain-free may be more apt to return to strenuous activity and thus strain soft tissues that lack extensibility and flexibility.

All treatments may be ineffective with some patients, however, early therapy for back and neck pain patients should begin with conservative care. This consists of treatment modalities and medication to reduce inflammation, soft tissue manipulation, spinal manipulation and mobilization, adjunctive physio-therapy modalities, rehabilitative physical therapy exercise, and postural and proprioceptive reeducation. Benefits of manipulation in back and neck pain are well-established in the literature, although randomized clinical trials designed for long–term follow-ups are definitely lacking.


In order to appreciate that manipulation may have beneficial effects on movement of the joint manipulated, consideration must first be given to the histological effects of immobilization on joints, resulting in hypo-mobile joint dysfunction.

Hypo-mobile joint dysfunction

Histological effects of immobilization and joints, result in increasing collagen synthesis with cross-linking between collagen fibrils; fibrofatty material is formed between joint surfaces, which leads to formation of adhesions. Production of “contracted capsule” that would result in loss of range of motion, which could be produced four basic ways:

  1. Scar formation of the capsule or capsular ligament does not have the same extensibility as normal ligament.
  2. Scar formation may occur between 2 ligamentous bundles that need to move independently.
  3. A scar within the ligament may increase the thickness such that its overall length is reduced.
  4. In a “creeping subluxation” the outside of the capsule may become “plastered down” to the periosteum of the articular processes of the joint, resulting in fibrocartilaginous metaplasia. Sequela to this is shortening of the capsule and synovium, with resultant loss of joint excursion.

Manipulation uses high velocity, low amplitude force (HVLA) to:

  1. Generate the kinetic energy necessary to overcome the resistance/restriction of abnormal restrictive barriers (mechanical effect).
  2. To produce a maximal frequency of discharge in the mechano-receptors in and around the joint (neurological effect).
  3. To take the joint to its maximal, normal end range of motion (mechanical effect), stimulating the maximal number of receptors (neurological effect).
  4. These effects enhance kinesthesia and position sense, producing temporal and spatial summation.
  5. The low amplitude force refers to the depth of thrust so the joint is taken through the restrictive barriers to its end range of motion, but not beyond, preventing over-distraction, sprain/strain or injury.
  6. Mechano-receptors are stimulated, recruited to fire and prevented from atrophy to restore proprioception and neuromuscular control, including normal sequencing, recruitment and coactivation of muscles to protect and stabilize the spine, and provide normal range of motion, kinematics and biomechanics.

Manipulative procedures constitute an important option in the treatment of back and neck related pain episodes. A growing list of research studies and reviews demonstrate that the services provided by Doctors of Chiropractic are both safe and effective.