Manipulation

Question 1

Paris definition

Answer 1

“The skilled passive movement to a joint with a therapeutic intent.”

Question 2

Guide to PT Practice definition

Answer 2

“A manual therapy technique comprised of a continuum of skilled passive movements to the joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small amplitude high velocity therapeutic movement.”

Question 3

Psychological effects

Answer 3

Hands on, therapeutic touch
Manually “finding” source of pain
Reproducing pain

Question 4

Placebo effect

Answer 4

patient’s perception of pain is reduced, the pop/snap sound provides placebo where the patient feels that an “event” occurred and something went back into place

Question 5

Theory of Synovial fluid “pop”

Answer 5

1 - reduced pressure in joint once pressure goes beyond a certain threshold; can be seen via x-ray; gas release causes a temporary gap until it is reabsorbed into Synovial fluid
2 - pop distends the capsule, fires type III mechanoreceptors and GTOs which cause inhibition/relaxation of muscles

Question 6

Neurophysiological effects

Answer 6

Gate control (type I and type II) 
Centralization of pain 
Muscle inhibition (type III) 
Movement and nutrition = physiological (Synovial fluid nourishes joint)

Question 7

Biomechanical effects

Answer 7

Stretch restrictions within capsule
Restore fiber glide
Restore ability to elongate
Stretch or snap adhesions b/w capsule and bone ends
Lubrication within capsule allows layers of collagen to slide, maintains GAGs and motion

Question 8

Critical fiber distance

Answer 8

Distance between fiber layers maintained by lubrication; decreased in this space promotes adhesions

Question 9

Stress strain curve

Answer 9

Stress: reaction of force in response to the outside force placed on the tissue
Strain: deformation
Toe region: taking up the slack
Elastic: no permanent changes
Plastic: deformation (lengthening)
Necking: weakening -> failure
Biological memory: tissue wants to go back to original length, you need HEP to maintain new range

Question 10

Chemical effects

Answer 10

Probable release of endorphins which cause pain reduction, weak research

Question 11

Indications

Answer 11

1 - Relief of discomfort by oscillation and repetitive motions to gate discomfort
2 - Restore ROM to aid in restoration of normal motion, help gate pain, assist in nutrition and repair and increase tolerance to insult

Question 12

Precautions

Answer 12

Instabilities, fractures, tumors
DIseases leading to instability such as RA, down syndrome
Rotational techniques with previous disc injuries