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MSPT II > Lumbar Manipulation > Flashcards

Lumbar Manipulation Flashcards

1
Q

Chiropractic Philosophy

A
  • Alterations in the vert. column lead to abnormal neural function—causing disease
  • Lesion: “subluxation”
  • Tx: removal of subluxations via “adjustments (chiro)” aka “spinal manipulation (PT)”
  • Chiro’s acct for majority of claims submitted for reimbursement for manipulation
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2
Q

Maitland Mobilization Grading

YOU KNOW THIS!!**

Grades I-V

A

see pics

Grades I,II== pain

Grades III-V== mobility

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3
Q

Manual Therapy

Define:

A

Intervention in which the hands of the provider apply forces to the pts soft tissues or joints

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4
Q

Joint Mobilization

Defined:

A

Manual Therapy involving mvmt or accessory motions of joint sometimes interpreted to include Grade V (thrust) techniques

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5
Q

Manipulation

Defined:

A

often to describe Grade V Thrust Techniques

sometimes used to describe any type grade of joint or STM

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6
Q

The Law

regarding Manipulation/Thrust Techniques

A
  • NJ PT Practice Act: PTs can both perform and use the word manipulation (thrust tech’s)
  • PA PT Practice Act: PTs can perform “manual therapy” or “jt mob” of any grade, including Grade V (thrust), but may NOT refer to it as a “manipulation”

Other 48– Practice Acts vary

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7
Q

MSK Purposes of Spinal Manipulation

4:

A
  1. Relief of pain
  2. Restoration of ROM
  3. Restoration of function
  4. Correction of positional/alignment faults—more DC’s
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8
Q

Proposed Mech’s of Pain Relief from Spinal Manipulation

Twomey & Taylor

A
  • Correction of malposition (subluxation)
  • Reduction of disc herniation
  • Eliminating adhesions around disc or facet
  • Repositioning of internal derangements, entrapped synovial folds, or plica w/in facet jts
  • Inhibitory stretch reflex from facet caps or afferent input from spinal tissues**** ASK!!!
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9
Q

Who Should Perform Manipulations

A
  • skilled practitioners
  • sparingly, appropriately
  • In PT–incorporate into comprehensive programs that includes pts ed, self-tx, ex, functional restoration, fitness, ergo’s, body mechs, posture*****

NOTE: Train pts in tissue altered state if you want to change the tissue***

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10
Q

SE’s of Spinal Manipulation

A
  • Common: Transient local discomfort/soreness
  • Less Common: HA, fatigue, dizzy/nausea, radiating discomfort
  • Rare Comps: fx, sublux, dislocation, vert aa injury, CE injury
    • <1 injury per 100,000,000 manips

*NOTE: Risks escalate if CONTRAINDICATIONS EXIST—-SCREEN ACCORDINGLY!!!

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11
Q

2 Tech’s for Spinal Manipulation

A
  1. Long Lever
  2. Short Lever
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12
Q

Long Lever Spinal Manipulation

A

**DOES NOT matter what segment you’re manipulating

  • Forces are applied @ some distance distal and/or proximal to the motion segment
  • Nonspecific UNLESS positioning is used so that force is directed at a specific motion segment
  • WE LEARNED 2 LONG LEVER TECH’S
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13
Q

Short Lever Manipulation Tech.

A
  • A specific motion segment is localized
  • Forces are applied directly to this motion segment
  • Ex. P-A glide over L5
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14
Q

Spinal Manipulation

Whats the “Pop”?

A
  • Cavitation
  • “Reduction”—Chiro
  • Unsworth et al.
    • sudden separation of jt surfs;
    • collapse of gas bubble inside joint
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15
Q

IS THE POP NECESSARY???

A

NO!!!

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16
Q

**IMPORTANT SLIDE**

CONTRAINDICATIONS FOR LS THRUST MANIPULATION

KNOW IT!!!

A
  • Spondylolisthesis
  • Osteoporosis
  • Metabolic bone dis’s
    • osteoporosis, Paget’s, etc.
  • Primary jt disease
    • RA, septic arthritis, etc.
  • Acute inflamm dis
  • Primary or metastatic malignant bone disease
  • Fx
  • Joint ankylosis (fusing)
  • Certain genetic disorders
    • ex. Down’s Syndrome
  • HypERmobility of the involved segment—rel. contraindication
  • B/L, Multisegmental, or progressive or severe neuro deficit
  • Sacroperineal (Saddle) numbness or parasthesias–CE syndrome
  • B&B signs–CE
  • Painful mvmts in all directions
  • Paralysis in a nonperipheral nerve distribution
  • HypERreflexia or presence of patho reflexes
  • Psychiatric disorders (if not under control)
  • Long hx of anticoagulant meds or steroids
  • Vert AA Disease–for CS manips
  • CN signs or sx’s or dizziness –for CS manips
17
Q

Evidence of Spinal Manips

A

CONFLICTING!!!

Some studies found more effective

Some studies not more effective

Conflicting—indicates need to look for a specific subgroup of pts w/ LBP that would benefit from manip

18
Q

What are we doing now w/ Spinal Manipulations and determining whether or not it is effective and for WHO?

A

More recent models focused more on development of a CPR

CPR– assists in class. process and improves decision making

Recent researc focused on baseline exam factors w/out assumptions based on theory or tradition

GOAL: ID pts likely to respond to manipulation, w/ rapid and sustained improvement defined as 50% or greater reduction in self-reported disability

19
Q

CPR for Manipulations

*REMEMBER MUST BE NO CONTRAINDICATIONS PRESENT!

5 Factors:

A
  1. Current sx duration < 16d (more acute)
  2. Work subscale of FABQ < 19
  3. HypOmobility of the LS assessed w/ P-A pressure– Spring Test
  4. IR of @ least one hip > 35degs –R/O OA
  5. Sx’s NOT extending distal to knee
20
Q

LS Manipulation CPR

With 4/5 CPR factors present……

A

Pts were HIGHLY LIKELY to improve

+LR= 24

Chance of improvement= 92%

*NOTE: W/ 2 or Fewer factors present…

  • -LR= .09
  • Chance of improvement= 9%
21
Q

Childs et al. Validation Study of CPR

A

see pics

22
Q

Important Components of the Manipulation CPR

**MOST IMPORTANT CRITERIA FOR MANIP CLASS.

What is it?

A
  • Short duration of symptoms < 16d
  • NO LEG PAIN distal to knee

**KNOW THESE!!!

23
Q

Important Components of the Manipulation CPR:

A
  • Short duration of Sx’s <16d*
  • No leg pain distal to knee*
  • Pts w/ 2 or fewer CPR factors very UNLIKELY to improve w/ manip
  • Pts >60yo NOT INCLUDED in dev. the CPR
  • Pts w/ signs of nerve root compression NOT INCLUDED ***
24
Q

Manipulation Techniques

A
  • importance of specific tech challenged
  • Thrust tech more effective vs. non-thrust
  • No current evidence one manipulation tech superior
  • Poor correlation b/w spinal lvls producting cavitation and actual targeted lvls
  • Selecting tech vs. predetermined tech== no better results
25
Q

Critical Factor to Optimal Outcomes w/ manipulation appears to NOT BE _____________, but ___________

A

NOT be which tech is used, but accurate ID of pts likely to respond

26
Q

To manipulate of not to manipulate, that is the question…

YES If…

A
  • NO CONTRAINDICATIONS PRESENT***
  • Exam findings support clinical decision making rule of Flynn et. al
    • ​**Recommended @ least 3/5 factors
  • Skills are adequate
  • Procedure is goal directed and part of a comprehensive program***
27
Q

To manipulate of not to manipulate, that is the question…

NO If…

A
  • CONTRAINDICATIONS ARE PRESENT***
    • must be NONE!!!
  • Exam findings are inconclusive that the pt is a good candidate
  • Skills are inadequate
  • Pt does not wish to be manipulated***
28
Q

Exam Components to help you determine if pt is a candidate for manipulation:

A
  • Medical Hx
    • any contraindications???
  • Hx Pain
    • Below knee? How many days current episode?
  • Segmental P-A motion testing
    • Spring test LS
  • Hip IR testing
  • FABQ
    • Work subset
29
Q

Manipulation Lab

  • Standard Manipulation Technique aka Classic SI Manipulation
A

See pics

30
Q

Manipulation Lab

  • Alternate S/L Manipulation Technique aka Neutral Gapping Tech.
  • **Symptomatic side UP!!
A

SEE PICS

31
Q

Basic ROM Ex’s AFTER MANIPULATION:

A
  • Prone press-up
  • Lower trunk rotation
    • from hooklying→ lower knees side to side
  • Alt. KTC
  • B/L KTC
  • mindful of directional preferences!!!

MSPT II (20 decks)

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