M3 Reading Guide Flashcards
What are the two most serious adverse events related to spinal manipulation?
- CES
- CAD
how does the risk of these events (CES/CAD) compare to the risk associated with medication use?
- HVLAT risk is significantly less
- NSAIDS for OA is 100-400x more risky than cervical manip
- Lumbar manip up to 150000x safer
Do the effects of spinal manipulation rely on careful detection of a segmental movement deficit?
- successful outcome linked to correctly identifying individuals who are responder to manipulation
- NOT accurate localization of dysfunctional segments
How large is the placebo effect of spinal manipulation?
Placebo accounts for 10-25% of the benefits of spinal manip
How does the addition of exercise affect outcomes in patients being treated using spinal manipulation?
- manip alon: 45% chance of success
- if 4/5 CPR factors present AND manipulation with exercise used, success rose to 95%
What are the six key exam findings that help a therapist recognize when a patient might benefit from spinal manipulation?
- No sx distal to knee
- Recent onset
- Low FABQ
- Hypomobility of L-spine
- Hip IR over 35˚ for at least 1 hip (measured prone)
- Regional deficits
Recent onset =
less than 16 days
CPR: Hypomobility of L-spine
- Lumbar AROM limited
- End-range pain (increased but no worse with repeated movement)
- PAIVM or PPIVM segmental hypomobility of lower thoracic, lumbar, SI regions
In addition to IR over 35˚ as part of the CPR, what else must be considered?
10˚ difference in IR between hips
CPR: regional deficits
- mobility
- muscle performance/length
- activity limitations
List the specific treatment options for a patient in the Manipulation & Mobilization Subgroup.
a. Lumbopelvic mobilization or manipulation
b. Muscle energy technique
c. Active ROM (anterior/posterior pelvic tilt - supine or quadruped, 10 reps, 3 to 4 x daily)
d. AROM and stabilization exercises
e. A/PROM to augment mob/manip
f. Address regional and fxl deficits
