Spinal Manipulation Flashcards
(42 cards)
Describe Grade I-V joint mobilizations.
Grade I: small amplitude, in early range of movement
Grade II: large amplitude, in midrange of movement
Grade III: large amplitude to point of limitation in movement range
Grade IV: small amplitude at endrange of movement
Grade V: small amplitude, quick thrust at endrange of movement
R1 is the [first/maximal] point of resistance felt.
first
R2 is the [first/maximal] resistance felt.
maximal
A thrust manipulation is a [low/high] velocity and [low/high] amplitude therapeutic movement within or at end ROM.
high velocity
low amplitude
What are manipulations intended to restore? (3)
(1) optimal motion
(2) optimal function
(3) reduce pain
T/F: A mobilization can include manual therapy techniques that are small amplitude, high velocity (i.e. manipulations)
True
What is the main difference between a mobilization and manipulation?
speed
mobilization = varying speeds and amplitudes (can include a manipulation)
manipulation = high velocity, low amplitude
What is the purpose of a “chiropractic” adjustment?
to correct subluxations of the spine and give freedom of action to impinged nerves that may cause pain or deranged function
What two states prohibit manipulation by PTs?
Arkansas and Washington
Which state prohibits manipulation but has an endorsement that would allow a PT to do so in their individual practice?
Washington
What is the main argument to support the practice of manipulation by PTs?
They are provided professional education that prepares them to do so!
What are the indications for spinal manipulation? (5)
improve motion, decrease pain, restore ease of movement/improved function, treatment based/patient selection criteria classification approach, and patients who are pain adaptive
What would NOT be an indication for spinal manipulation? (2)
(1) to put the back in alignment
(2) to adjust a subluxed joint
What are the criteria from the Treatment Based Classification System? (5)
(1) no symptoms distal to knee
(2) recent onset of symptoms (<16 days)
(3) low FABQ (<19)
(4) hypomobility of lumbar spine
(5) hip internal rotation >35
What characteristics make a patient “pain adaptive”? (4)
- Clear aggravating and easing factors.
- Have the endogenous (within their own body) ability to modulate pain without medical interventions
- Tend to react quickly to pain, but also modulate pain endogenously, often within the same treatment session
- Nociceptive pain drivers.
What characteristics would make a patient a “non-pain adaptor”? (5)
- Persistent pain patterns.
- Limited endogenous (within their own body) ability to modulate pain
- Tend to react slower to pain stimulus, but also pain persists
- Not responsive within the same treatment session
- Nociplastic (central sensitization) pain drivers.
What are the contraindications for spinal manipulation? (GO!)
anti-coagulant therapy, downs syndrome/RA, vertebral artery compromise, osteoporosis, infectious disease, malignancy, relevant recent trauma or fracture, fusion, gross spondylolisthesis, severe unremitting nighttime pain, multi-level nerve root pathology, worsening neurologic function, upper motor neuron lesions
What are the precautions to spinal manipulations? (9)
inflammatory disease, cancer history, long-term steroid use, osteopenia, hypermobility syndromes, connective tissue disease, cervical anomalies, recent manipulation by another health professional, and patient equipoise
The risk of cauda equina following spinal manipulation is ______.
<1/100 million
What are the common side effects of manipulation? ()
local discomfort, fatigue, headache, radiating discomfort, stiffness, dizziness, or muscle spasm (resolve in <24 hours)
What are biomechanical explanations for how spinal manipulation works?
- Short term mechanical change in vertebral position
- Short term mechanical increase in range of motion
- Improvement in impairment associated with movement
- Changes in the diffusion of water within the lumbar intervertebral discs at the L1-2, L2-3, and L5-S1 levels after treatment of spinal manipulative therapy
- Improved activation of lumbar multifidus following lumbar manipulation
T/F: Spinal manipulation techniques are specific to a segment.
False, they aren’t specific to a segment or necessarily an area of the spine (i.e. cervical, thoracic, or lumbar)
What are neurophysiological explanations for how spinal manipulations works?
- Spinal Cord Hypoalgesia (↓sensitivity to pain)
- Sympathoexcitatory (blood flow, heart rate, skin conductivity, temperature changes)
- Decrease of Temporal Summation (lowered pain perception)
- Peripheral inflammatory mediators (change blood levels of inflammatory mediators)
- Central Mediated (changes in pain “experience” in CNS)
- Endocrine Response (Opioid responses, B-endorphins)
- Muscle Reflexogenic (↓ muscle hypertonicity)
- Descending inhibition
How long to neurophysiological effects of manipulation last?
15-20 minutes (short lasting)
