Forces Generated Through SMT

Question 1

Theory 2: relaxation of hypertonic muscle by sudden stretching

Answer 1

• The theory believes that manual techniques such as high velocity thrusts or adjustments can normalise abnormal motor tone caused by the stimulation of inhibitory afferents by manipulation.
• This theory is highly unlikely as sudden stretch produced by this form of manipulation will excite rather than inhibit the motor neuron

Question 2

Theory 3: disruption of articular or peri articular adhesions

Answer 2

-Manipulation of a fixation that is maintained only by the sub-atmospheric pressure and the cohesive behaviour of the SF has the potential only to temporarily increase range of motion
- these adhesions however are likely to be of a collagenous nature and would thus have viscoelastic properties
( adhesions may decrease range of movement. But coz fibrous tissue is not innervated by nociceptive fibres it does not explain spinal pain)

Question 3

Theory 4: unbuckling of motion segments that have undergone disproportionate displacement

Answer 3

The theory States the realignment of joint subluxations or the replacement of fragments from the nucleus pulposus of the intervertebral disks after HVLA manipulation .
This positional theory has been proven to be false
As for the replacement of fragments from the nucleus pulposus theory, this is also unlikely because you can cavitate other joints that don’t have a nucleus pulposus such as MCP joints

Question 4

Contra-indications for manipulative therapy -RELATIVE

Answer 4

• acute disc herniation
• osteopenia
• spondylathropathy
• anti coagulation
• bleeding disorders
• psychological overlay

Question 5

Contra-indications to manipulative therapy- ABSOLUTE

Answer 5

• progressive neurological deficit
• destructive lesions of the spine, ribs or pelvis
• healing fracture or dislocation
• avascular necrosis of bone in the axial skeleton
• segmental instability
• cauda equina syndrome
• aortic aneurysm
• malingering

Question 6

Theory 1: release of entrapped synovial folds or plica

Answer 6

• The theory is that if the synovial folds became pinched between the articulating facet surfaces of the zygopophyseal joints it may cause (because there are nerve fibres coursing through synovial folds that were most likely nociceptive) acute low back pain.
• this theory demands that the joint be in or near to a neutral position for only in that position are the articular surfaces sufficiently apposed to trap a synovial fold. Therefore entrapped synovial folds would only cause pain on extension of the lumbar spine but not upon flexion of the lumbar spine

Question 7

Name four structures that stabilise a joint?

Answer 7

Ligaments
Capsule
Soft tissue
Sub atmospheric pressure

Question 8

Name two barriers of a joint

Answer 8

Physiological barrier

Barrier of anatomical integrity

Question 9

Indications for spinal manipulative therapy

Answer 9

Posterior joint dysfunction
Muscle syndromes
Joint dysfunction co-existing with spinal stenosis
Joint dysfunction co-existing with spondylolisthesis
S.I sundrome