Adjustive complications

Question 1

What is a mild reaction to manipulation therapy and how common is it?

Answer 1

local discomfort, headache, tiredness or radiating discomfort for less than 48hr. 64% symptoms 1st 4hrs and 74% disappear w/in 48hrs.
It is common - with 85% of cases having mild to moderate treatments.

Question 2

Moderate to sever reactions to manipulation therapy are indicated by?

Answer 2

mild symptoms lasting longer than 48hrs or under 48hrs more acute and affects patients ability to work.

Question 3

Why is it difficult to estimate the rate of serious lumbar manipulative complications?

Answer 3

lack of prospective documentation
uncertain in number of manipulations delivered
low incidence of complication

Question 4

rates are low for serious complications regarding what?

Answer 4

Lumbar complications

Question 5

Terrett and Kleynhans list of complications.

Answer 5

Disc, diagnostic error, vascular (thrombosis), fracture, rib fracture, osteoporosis, patient on anti-coagulant, inguinal/abdominal hernia

Question 6

How common is compression of the cauda equina by mid line herniation? What levels are associated with this?

Answer 6

Is most frequent described spinal complication from manipulative therapy.
It is associated with the 3, 4, 5 IVD’s

Question 7

Majority of malpractice claims filed are because of what?

Answer 7

disc problems

worsening existing herniation

Question 8

What are the debates on side posture manipulation regarding disc herniation?

Answer 8

Based on bio-mechanical models of Lx rotation and disc injury. Facets limit Lx rotation restricting torsional stress.
Increased risk is w/ flexion and rotation

Question 9

Bogdux model on manipulation regarding disc herniation.

Answer 9

forced rotation may exceed normal sentimental range (2 degrees).
Damage w/ fracturing facet.

Question 10

The Bogdux model’s bio-mechanics of injury suggest what?

Answer 10

shear and torsion is focused on contra lateral facet, flexion of segment compromises the disc.
At 3 degrees of motion 4% micro failure occurs.
Full failure at 12 degrees

Question 11

debate on rotation and rotational manipulation

Answer 11

facet fracture b/4 disc injury

disc most vulnerable in flexion/rotation

Question 12

Claims reported on joint or SI sprians?

Answer 12

uncommon, could be because most fall into an excessive reaction not a complication.

Question 13

Are compression fractures likely with manipulation?

Answer 13

Unlikely