Thrust Manipulation Flashcards
What does US physical therapy history say about manipulation
Mary McMillan - 1st president of APTA (1921)
4 branches of PT:
Manipulation, thre ex, electrotherapy, hydrotherapy
McMillan’s 1921/1925 book - states that (massage/manip vs. exercise)
Massage (manipulation) = movements done upon the body
Exercise = movements done with a part of the body
Current history and the future - Evidence based practice
Evidence shows that manipulation and exercise are PTs most useful tools
Historical summary
No one profession invented or owns manipulation
Multiple practioners doing it
Manipulation has been a vital part of the scope of PT practice since the inception of the profession!
Manipulation definition
The skilled passive movement to a joint and/or the related soft tissues at varying speeds and amplitudes including a small amplitude, high velocity therapeutic movement
Thrust manipulation =
High velocity, low amplitude therapeutic movement within or at the end of range
Non-Thrust manipulation =
Manipulation that does not involve a thrust
Grade 1
Small amp, does not touch resistance
Grade 2
Large amp, does not touch resistance
Grade 3
Large amp, touches resistance
Grade 4
Small amp, touches resistance
Grade 5
High velocity, low amp
Performed at end range!
Indications - Mechanical
Hypomobility Joint fixation/acute joint lock Somatic dysfunction Restore bony alignment Meniscoid entrapment/displaced disc fragment Adhesions
Indications - Physiological
Pain modulation Reflex relaxation of mm Reprogramming the CNS Mm facilitation Release of endorphins
Absolute contraindications
Bone pathology Neurological Vascular Lack of diagnosis Lack of pt consent Pt positioning
Absolute contraindications - Bone pathology
Tumor Infection Metabolic Congenital Inflammatory Iatrogenic Traumatic
Absolute contraindications - Neurological
Cervical myelopathy
Cord compression
Cauda equina
CNS disorder
Absolute contraindications - Vascular
Aortic aneurysm
Vertebral artery insuf
Carotid artery dysfunction
Bleeding/clotting disorder
Relative contraindications
Adverse rxn to previous MT Disc herniation Inflammatory arthritides Pregnancy Spondylosis, listhesis, DJD OP Anticoagulant or steroid use Psych dependence Vertigo Lig laxity, joint instability, preg Arterial calcification Worsening condition
Evidence regarding safety - Acute LBP - risk of cauda equina
1 in 100 million manips
Evidence regarding safety - cervical spine
1/400,000 to 3/10 million
Very rare, but when it does happen - it is very serious
Principles of application - Joint gliding
Knowledge of anatomy/kinesiology
Plane of the joint, right angles, or with distraction
Principles of application - Localization
Limits procedure to joint being treated
above and below
Principles of application - Locking
Apply leverages to lock uninvolved segments
Never lock the segment you wish to manipulate
Apposition locking/Ligamentous myofascial
Principles of application - Levers
Short = one vert is held while force is applied to adjacent vert and resultant force is sufficient to move one segment on the other - one segment moving directly against the other
Long = use of an extremity or multiple spinal segments in a locking maneuver - pulling on the leg to manipulate the spine
Principles of application - Velocity
High
Applied after the slack is removed
Principles of application - Amplitude
Force is applied quickly over a short distance
Smaller amp with a short lever
Principles of application - Balance/control
Pt and therapist safety and comfort
Principles of application - Cavitation
Audible pop - may or may not happen
Sudden dec in intracapsular pressure
Dissolved gasses in the synovial fluid release into joint cavity
Followed by elastic recoil of synovial capsule
Validation of clinical practice by research
Patient classification
Clinical guidelines
Measuring outcomes
