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SMT > SMT-1 (Part 2) > Flashcards

SMT-1 (Part 2) Flashcards

1
Q

Based on Triano (1992), Studies on the Biomechanical Effect of a Spinal Adjustment. Intervention: C2/3 cervical lateral break technique

-How fast is the “high-velocity” in thrust for the CS?

A
  • Was 0.135 seconds
  • Mean time from onset of the manipulation thrust to its peak force development was 0.135 seconds

• That is essentially 1/10 th of a second; close to physiological reaction times

– Thus, the biomechanical effects of manipulation are completed prior to any protective muscular response that might develop

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2
Q

Based on Triano (1992), Studies on the Biomechanical Effect of a Spinal Adjustment. Intervention: C2/3 cervical lateral break technique

Mean cervical thrust duration?

A

Mean thrust duration: 135 ms

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3
Q

Based on Triano & Schultz (1994) JMPT; 17, 573-583

How much CS pre-thrust rotation?

A

Found 40 degrees of pre-manipulative rotation & 18 degrees of flexion

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4
Q

Based on Herzog et al. (1993)

How fast is the “high-velocity” in thrust in the CS?

A

80-200 ms

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5
Q

Based on Herzog et al. (1993)

What is the Mean cervical thrust duration?

A

– Mean thrust duration: 80 ms to 200 ms

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6
Q

Klein et al. (2003) Clinical Biomechanics, 18, 827-831

In the CS (C3 to C5) How much pre-thrust rotation there is?

A

Mean of:
30 degrees of axial rotation
46 degrees of lateral bending
2 degrees of flexion for cervical HVLAT of C3 and C5 levels

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7
Q

Based on Klein et al. (2003) Clinical Biomechanics, 18, 827-831

What are the 3D Kinematics of cervical HVLAT for C3 and C5 levels?

A

56 manipulations realized and audible release on 46 cases (28 of 56 required two attempts)

– The side and the spinal level (C3 or C5) did not influence 3D ranges of motion;

• The angular displacements were not larger for C5 manipulation than for C3.

• You don’t rotate or lateral flex “down to” the levelthis is NOT necessary.

• Components are applied at the level to be manipulated only.

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8
Q

Based on Klein et al. (2003) Clinical Biomechanics, 18, 827-831. On the 3D Kinematics of cervical HVLAT for C3 and C5 levels

What is the mean ROM obtained?

A

The mean ROM obtained: 30 degrees of axial rotation, 46 degrees of lateral bending, & 2 deg flexion.

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9
Q

Based on Klein et al. (2003) Clinical Biomechanics, 18, 827-831. On the 3D Kinematics of cervical HVLAT for C3 and C5 levels

Axial rotation and lateral bending are always ?

A
  1. Axial rotation and lateral bending were positively correlated.
    1. Rotation and lateral bending were always of opposite direction.
  1. This heterolateral coupling contrasts with the normal behaviour
    of the lower cervical spine, for which homolateral coupling is described. • Importance of heterolateral coupling during cervical HVLAT remains unclear.
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10
Q

What are the difference between CS and LS Kinematics?

A

CS and LS kinematics are opposite.

When performing Right side bending on the CS the right facet join are in close position (same side close)
but when we perform a LS right side bending the right side will be open (same side open)

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11
Q

Based on Klein et al. (2003) Clinical Biomechanics, 18, 827-831. On the 3D Kinematics of cervical HVLAT for C3 and C5 levels

  1. How many degrees of flexion did the audible release was associated ?
  2. How many people had audible release in slight increase of extension and with -3 degrees of extension?
A
  1. Audible release was associated with 2 deg of flexion in 42 of 45 maneuvers
  2. (3 of 45) that had an audible release with slight increase in extension; no audible release was associated with mean of – 3 extension.

– Peak rotation and peak lateral bending occurred simultaneously—this instant was defined as that of the thrust.

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12
Q

Based on Klein et al. (2003) Clinical Biomechanics, 18, 827-831. On the 3D Kinematics of cervical HVLAT for C3 and C5 levels

  1. How many seconds did it take from contact/the start of movement of the head to the moment of thrust?
A

*mean of 7 seconds from contact/the start of movement of the head to the moment of thrust!

Thus, constructive fiddling or setting up optimal barrier/components takes a few seconds…..

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13
Q

Based on Klein et al. (2003) Clinical Biomechanics, 18, 827-831. On the 3D Kinematics of cervical HVLAT for C3 and C5 levels

  1. What were the largest ranges subjects obtained?
  2. What were the smallest ranges subjects obtained?
A
  • Largest: 46 degrees rotation, 62 degrees of lateral flexion, 23 degrees of flexion

*Lowest: – 12 degrees rotation, 31 degrees lateral flexion, 0 degrees flexion

• Except for lateral bending which was close to active range, the motion ranges obtained during HVLAT manipulation were well below active ROM reported in the literature.

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14
Q

Based on Klein et al. (2003) Clinical Biomechanics, 18, 827-831. On the 3D Kinematics of cervical HVLAT for C3 and C5 levels

  1. CS mid-range HVLAT or end-range HVLAT? Do we really enter the paraphysiological range?
A

For the cervical HVLAT manipulation, the maximal amplitude between head and trunk:

  1. Does not exceed physiological active ROM.
  2. The amplitude for rotation, which is generally assumed to involve greatest risks for negative side effects, is significantly lower than during active motion.
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15
Q

Base on Kawchuk et al (1992) CS Results:

  1. How much force needed for cervical HVLAT?
  2. Mean peak force for HVT?
  3. Mean duration of force for cervical HVT?
  4. Time to peak force?
A
  1. Less force & faster speeds are needed for effective cervical HVT
  2. Mean peak force for cervical HVT was 118 N (+/- 16 N); BUT 6 HVTs only!
  3. Mean duration of force for cervical HVT: 102 ms (+/- 15 ms)
  4. Time to peak force: 48 ms (+/- 15 ms)

– Mean joint compliance of the joint manipulated increased by 0.5 mm from pre to post HVT compared with 0.1 mm for non-HVT side (contralateral)

– Cervical manipulation is less forceful and inherently faster than manipulation used elsewhere
(More SPEED for when manipulating the CS spine and more AMPLITUDE for the LS)

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16
Q

Based on Herzog & Symons (2001) thoracic manipulation study.

How much force for thoracic HVLAT:

  1. Preload?
  2. Mean (global) Peak Force?
  3. Average rate of force application?
A
  1. Preload mean force (mean force observed during the 500 ms preceding the treatment thrust) = 24 N
  2. Mean (global) peak force = 238 N, but local peaks over 25 mm sq. area only 5 N
  3. Average rate of force application was 1368 N/s.
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17
Q

Based on Herzog & Symons (2001) thoracic manipulation study.

What is the peak pressure point moved during the course of the manipulation:

A

On average 9.8 mm during the course of the manipulation (i.e. 1 cm)

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18
Q

Based on Herzog & Symons (2001) thoracic manipulation study.

How much force for thoracic HVLAT:

What is the peak preload force duration showed just before the thrust ?

What is the factor of total force pre load to peak force increased by?

A
  1. Preload force showed a DECREASE just before the thrust and reaches peak in 150-200 ms = duration of thrust
  2. Total forces from pre load to peak force increased by a factor of 10!
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19
Q

The average x-displacement (superior movement) based on Bereznick et al. 2002 Frictional properties of thoracic
skin fascia interface: Implications in spine manipulation study.

A

The average x-displacement (superior movement) was 38.75 mm (ranges from 12.5 to 70.0mm)

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20
Q

The average In the absence of removing the skin slack first based on Bereznick et al. 2002 Frictional properties of thoracic
skin fascia interface: Implications in spine manipulation study.

A

33.25 mm (range 15 to 45 mm during thrust from start to finish) The skin moves, not the vertebrae. Thus losing contact with the targeted vertebral region.

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21
Q

Clinical implications of frictional properties of thoracic skin fascia interface based on Bereznick et al. 2002.

How much approximately must you take of skin slack first to get SKIN LOCK so you remain on the vertebrae you think you are on:

A

33 mm to 38 mm

22
Q

Clinical implications of frictional properties of thoracic skin fascia interface based on Bereznick et al. 2002.

How many cm approximately must you take off skin slack first to get SKIN LOCK before you thrust in the thoracic spine in a prone position?

A

3 cm

23
Q

Why is it important to take the skin slack before manipulation?

A

Limits the x-displacement excursion during the thrust, allowing the therapist to maintain original bony contact

24
Q

Conclusion of Clinical implications of frictional properties of thoracic skin fascia interface based on Bereznick et al. 2002.

  1. For example, will a force on a 45-degree angle reduce its magnitude?
  2. Only perpendicular regular forces:
  3. What this study challenges:
A
  1. 70.7%
  2. Only normal force components (perpendicular forces) will be transmitted, while shearing forces will be transmitted to the surrounding tissues.
  3. The concept that directional specificity during spine manipulation is required to generate a desirable therapeutic outcome
25
Q

Relationship between preload and peak forces during spinal manipulation:

  1. How much preload force is needed based on Herzog et al (1993)
  2. How much force is needed in the thrusting phase based on Herzog et al (1993)
A
  1. Preload: extends over several seconds, a pre-load force that is relatively constant immediately preceding the manipulative thrust
  2. Thrusting phase: 80-200 ms and culminate in the peak thrusting force
26
Q

What is the purpose of the preload phase based on Herzog et al. (1993)?

A

To move the joint on interest to near the end range of passive motion (combination of leverages)

27
Q

What is the purpose of the manipulative thrust based on Herzog et al. (1993)?

A
  1. Restore joint integrity
  2. Restore joint range of motion
  3. Pain Reduction via relaxation of hypertensive muscle surrounding the treatment area.
28
Q

What is the thrust duration for the CS and TS/SIJ based on Herzog et al (1993) study:

A
  1. For the CS was 90-100 ms
  2. Fos the TS & SIJ was 120-200 ms
29
Q

T or F

Peak thrusting Force is very closely associated with the amount of preload force

A

True

30
Q

True or False

A “stiff” joint requires more pre-load Force than a “soft” joint

A

True

31
Q

True or False

A larger peak thrusting force is required for a stiff joint than a soft joint?

A

True

32
Q

What are some things to know about contraindications to the HVLAT?

A
  1. Exclude RED FLAGS and consider Yellow flags.
  2. Must consider risk-to-benefit ratio
    The benefit to the patient must outweigh the potential risk associated ith the intervention.
33
Q

What are the absolute contraindications of spinal manipulation HVLAT?

A
  1. Vascular (CAD, aortic aneurysm > 5 cm, severe hemophilia)
  2. Bone (tumor, TB infections, metabolic like osteomalacia, congenital dysplasias, fracture, iantrogenic like long term of corticosteroid use, active inflammatory disease (RA), fracture, upper CS instability
  3. Neurological: Cauda equina, cervical myelopathy, Chiari malformation, radiculopathy (BUT not neurogenic pain for absolute contraindication)
  4. Excessive or extreme pain
  5. Lack of clinical diagnosis (Dxs first)
  6. Lack of patient consent
34
Q

What are the relative contraindications of spinal manipulation HVLAT?

A
  1. Disc herniation
    * 49-63% of individuals who have never had a significant bout of LBP have HNP based on MRI (1500 hospital employees, Boston).
    * Risk of worsening LDH: 1 in 3.7 million (oliphant et al 2002)
  2. Prengnacy:
    DO NOT thrust at the 12th and 16th weeks (3 and 4th month) higher probability of miscarriage
  3. Osteoporosis, RA
  4. spondylolysis and spondylolisthesis
    *AVOID extension and do primarily lever of flexion or non thrust procedure
  5. Advance DJD or spondylosis
35
Q

At what time therapist should not manipulate a pregnant woman:

A

DO NOT thrust at the 12th and 16th weeks (3 and 4th month) higher probability of miscarriage

36
Q

How Old Can you manipulate someone?

A

None (no restriction): Just watch for Dx’s of osteopenia or osteoporosis.

37
Q

What age is the youngest to manipulate?

A

None (no restriction): If a controlled, accurate, and short lever is used, there should be no problem. ( Hartman 2001)

*DON’T deny the opportunity to children won’t damage them. You are not putting in as much force.

38
Q

What to screen for before HVLAT:

A
  1. Vital sign
  2. History of Trauma
  3. 5 D’s (Dysarthria, Diplopia, dysphagia, Dizziness, Drop attack)
  4. AND: Ataxia
  5. 3 N’S (Nausea, Numbness, Nystagmus)
38
Q

Based on Reggars (1996)

How many clicks will likely occur during spinal manipulation?

A

*At least one audible joint crack sound
* An average of 2.5 cavitations per subject per thrust

*Only 9 (18%) subjects produce a single crack

*82% of subjects produce 2 or 3 distinct cracks

39
Q

What was the Reggars (1996) study about:

A

They wanted to know how many clicks or audible will occur with HVLAT.

N=50 asymptomatic college student from Macquarie University, New South Wales)

Intervention: Single unilateral rotatory applied to C3/4 zygapophyseal joint

Outcome: Joint crack sound wave analysis of digital audio tape recordings taken from 2 skin mounted microphones on either side of the cervical spine

  • All 50 manipulations of C3/4 resulted in at least one audible crack.
    –> Total of 123 joint cracks
    -9/50 resulted in a single crack (18%)
    • 32/50 resulted in 2 or 3 cracks (64%
    • 7/50 resulted in 4 cracks (14%)
    • 2/50 resulted in 5 cracks (4%)
40
Q

How many cracks did C3-4 result after HVLAT?

A

Between 1-5 cracks
With Waveform frequency of @ 33# Hz (95% CI: 285 and 380 Hz)

  • No statistically significant difference in the number of joint cracks was found for between sexes or for a previous history of trauma and no trauma
41
Q

Is spinal manipulation accurate & specific to the target segment?

A

NO.

42
Q

What study shows that spinal manipulation is NOT accurate or specific to the target vertebral segment?

In the Lumbar Spine

A

Ross et al 2004.

  1. For LS result study
  2. Only 36.5% of manipulation resulted in a single cavitation; the remainder (63.5%) produced 2-6 “pops”
  3. Only 57 of 124 Lumbar thrusts deemed accurate to target vertebrae
  4. Average error from the target joint was 5.29 cm (0-14 cm)
  5. Average discrepancy error was one level above or below the target vertebrae
  6. When a lumbar thrust results in just one cavitation, the average error from the target level was 3.9 cm (range 0-19 cm)
43
Q

What study shows that spinal manipulation is NOT accurate or specific to the target vertebral segment?

In the Thoracic Spine

A

Ross et al 2004.

  1. TS
  2. Average error from target joint= 3.5cm
  3. Only 3/17 thoracic manipulation resulted in a single cavitation
  4. Most thoracic thrusts produce 2-6 cavitation.
  5. When only 1 or 2 cavitations occur, there is less likelihood of cavitating the target joint.
  6. When cavitating, 4 or more joints have a high likelihood of cavitation of the target joint.
44
Q

What other study shows:

Does the thrust cavitate the target joint?

A

Beffa & Mathews (2004) South African study

*Sample: 30 asymptomatic volunteers divided equally into 2 groups of 15. Group 1 (received L5/S1 manips, and group 2 was SIJ mani, both lateral recumbent positions.

*Intervention: L5/S1 manip or SIJ manip

*Outcome: The subject had 8 microphones taped to their skin over the 3rd, 4th, and 5th lumbar facet joints and PSIS (SIJ). Radiographs were used to ensure the microphones’ accurate placement. The sound signals produced during the adjustment were digitized.

Results: There was no statistically significant correlation between the anatomical location of the cavitation sound and the adjustment technique selected.

45
Q

The main result of the Beffa & Mathews (2004) South African study was

A

There was no statistically significant correlation between the anatomical location of the cavitation sound and the adjustment technique selected.

  • L5/S2 thrust cavitated the L3/L4 upside facet most often.
    *SIJ thrust cavitated the L5/S1 upside facet more often than SIJ

–Indicating that the two different methods of manipulation did not produce cavitation at significantly different locations

46
Q

Based on what study:

What is the popping sound?

A

Unsworth (1971)

Hypothesized to be CO2 coming out of solution. Cavities bubbles in the synovial fluid.

47
Q
  1. Based on the study, do joint space changes post-HVLAT?
  2. What is the increase in resting post-cavitation MCP joint space of:
A
  1. Unsworth (1971)
  2. Increased: 0.42 mm 5 min after HVLAT.
    0.01 mm in 10 min after HVLAT.
    0 mm 15 min after HVLAT manipulation.
48
Q

Cascioli et. al (2003) study show:

A

-No significant joint space separation or density values are demonstrated in the zygapophyseal joints of the cervical spine after HVLAT.

-No evidence of gas in the joint space or increased zygapophyseal joint width immediately after cervical HVLAT. Based on CT and Xray after traction.

-Propose capsular detonization theory proposed by Sandoz (1969)

49
Q

What is capsular detonization theory:

A

Explanation of why the synovial joint does not “RE-Crack” for 15-30 min after it has been cavitated.

When stretched beyond a certain point (without being torn), the collagen fibers of a particular capsule shorten to regain their original length. A second crack sound cannot be elicited until the collagen fibers return to their original length.

SMT (5 decks)

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