Physiotherapy and Osteopathic Treatment for Pain in the Cervical and Lumbar Spine and Temporomandibular Joints

In the treatment of acute cervical and lumbar spine pain, low-frequency pulsed magnetic field therapy is applied as an analgesic, anti-inflammatory, and anti-edematous modality. The procedure lasts 30 minutes and is performed using the same parameters for both regions: magnetic field intensity 4 mT, pulse frequency 15 Hz, and pulsatile mode. In cervical pain syndromes, this therapy helps reduce pain, muscle tension, and tissue swelling, while improving local microcirculation. In lumbar pain complaints, it contributes to pain relief, reduction of paraspinal muscle tension, improved blood supply, and stimulation of metabolic activity in tissues. Its anti-inflammatory effect may also support faster restoration of spinal mobility and improve the patient's overall functional comfort.

Before the procedure, the physiotherapist selects an orthopedic collar appropriate to the patient's neck height and circumference, explains the purpose of its use, and positions the patient sitting or supine with the head in a neutral position. The collar is applied by gently lifting the chin, supporting the mandible with the contoured front part, and placing the lower edge evenly on the sternum and clavicles. The posterior part is then positioned behind the neck and secured with Velcro straps, ensuring proper stabilization without excessive pressure, breathing difficulty, discomfort, or impaired swallowing. After fitting, the patient is instructed to wear the collar for 3 hours, avoid sudden head movements, and monitor for adverse symptoms such as pressure pain, dizziness, or dyspnea. Light daily activities are allowed if recommended. After 3 hours, the patient removes the collar carefully while maintaining the head in a neutral position and reports any concerning symptoms.

The physiotherapist selects a lumbar brace appropriate to the patient's body shape and trunk circumference, explains its purpose, and positions the patient standing or sitting with the trunk upright and the spine in a neutral position. The brace is applied over the lower back so that it covers the lumbar region and fits closely to the body. The lateral parts are brought forward and fastened over the abdomen with even tension; additional elastic straps may be tightened to improve stabilization without restricting breathing or causing discomfort. The therapist then checks the brace position, symmetry, and patient comfort. The brace is worn for 3 hours during daily activities performed according to therapeutic recommendations. The patient is advised to avoid heavy loads, sudden twisting movements, and lifting. They should monitor for pressure, abdominal pain, dyspnea, or skin irritation. After 3 hours, the patient removes the brace independently, checks the skin, and stores the brace.

Positioning postures are used in acute pain management to find a body position in which symptoms are clearly reduced or completely relieved. The selected posture should be comfortable, natural, and free from forced tension. The therapist identifies the most relieving position and maintains it for 30 minutes, making small corrections if pain or discomfort reappears. In cervical spine pain, the patient lies supine with the head supported on a pillow or in the therapist's hands. Gentle movements such as slight flexion, extension, rotation, or lateral flexion are introduced until the most comfortable setting is found, often slight flexion combined with rotation away from the painful side. In lumbar spine pain, the patient also lies supine, while the therapist tests hip and knee flexion, support under the legs, or slight pelvic rotation. The chair position is most often the most relieving. The aim is to reduce pain, relax muscles, and unload spinal structures.

Visceral therapy begins with 3-5 minutes of patient preparation in the supine position with slightly flexed knees to relax the abdominal wall. After a brief interview and palpatory assessment of the abdomen, thorax, and pelvis, the therapist identifies areas of increased tension and dysfunction. The first 10-minute phase focuses on structures functionally related to the cervical spine, including gentle mobilization of the upper thoracic outlet, cervicothoracic junction, clavicular region, esophagus, stomach, and cervical fascial structures, in order to reduce tension and improve drainage. The next 15-minute phase addresses the lumbar region through mobilization of the respiratory diaphragm, liver, gallbladder, intestinal flexures, urinary bladder, and associated pelvic fascial structures. Additional work on the parietal and visceral peritoneum aims to improve organ mobility and reduce fascial restrictions. The final 5 minutes include global balancing techniques, followed by postural

General Osteopathic Treatment (GOT) begins with the patient in a relaxed supine position. After brief palpation of the neck, shoulder girdle, and pelvis, the therapist starts rhythmic mobilization of the upper limbs and shoulder girdle, using smooth, moderate movements to induce relaxation and reduce tension in the cervical region and indirectly in the temporomandibular area. The next stage involves gentle mobilization of the cervical spine with subtle flexion, extension, rotation, lateral flexion, and light traction synchronized with exhalation, aiming to decrease muscle tension, unload intervertebral joints, and improve circulation. The therapist then mobilizes the hips, lower limbs, and pelvis with light traction, oscillation, and rotational movements to restore lumbar balance and reduce low back pain. The final phase includes global, gait-like alternating limb movements coordinated with breathing, promoting overall relaxation, fascial balance, and integration of body tensions.