accessory mobilisations for spine

Question 1

how to perform

Answer 1

informed consent, contraindications, expose back, position patient prone, plinth high enough, x30 reps

grade 1: Small amplitude/movement, no resistance
2: large amplitude, no resistance
3: Large amplitude, in resistance
4: Small amplitude, in resistance
5: Small amplitude, high velocity

PA - on SP
transverse - medial/lateral on SP
unilateral - on TP

cervical: thumbs
lumbar: pisiform

Question 2

contraindications / precautions

Answer 2

MSK: osteoporosis, radiography, surgery, unstable & artificial joint, infection & recent surgery on joint, cancer, unstable fracture
CR:
CV: anti-coagulant drugs
N: no consent, fear
pregnancy, unknown/chronic pain, dependency, infection, not reached skeletal maturity, bone density problems, eating disorder, previous failed response

Question 3

rational

Answer 3

Manual therapy - hands applying force with therapeutic intent, using external force to mobilise a joint
increases elasticity & nerve mobility, reduces stiffness, pain & swelling, relaxes muscle tone
increases RoM in a painful/non painful joint for better overall function

Question 4

physiological effects

Answer 4

Increase joint movement, stretch adhesions
Decrease pain & muscle spasm
controlling pain at spinal cord level
Function, less fear, sleep
dopamine release, cortisol
improved blood flow, lymphatic drainage, healing, removing toxins

Question 5

structures, how?

Answer 5

vertebral muscles, erector spinae - indirectly reducing tension
soft tissues & fluid in vertebral facet joints, intervertebral discs, capsular ligaments, nerve tissue - lessening restriction, aligning, reducing stress/loading & compression, loosening, mobilising

MSK, NS, circulatory

Question 6

principles

Answer 6

grades 1-5
choose grades based on joint stiffness, pain, fear
1-2: painful joint
3-4: stiff joint
deciding method position, range, amplitude, rhythm and duration based on restriciton
Concave-convex rule - stable convex, moving concave surface
glide in same/opposite direction as joint movement

Question 7

Which spinal patients are most likely to benefit from mobilisations?

Answer 7

Symptoms for less than 16 days
No symptoms below the knee from the spine
Score less than 19 on Fear-Avoidance Belief Q
At least 1 stiff lumbar segment
1 hip with greater than 35° internal rotation